Association of maternal and/or fetal factor V Leiden and G20210A prothrombin mutation with HELLP syndrome and intrauterine growth restriction

Abstract

This study was conducted to investigate the association of maternal and/or fetal factor V Leiden (FVL) and G20210A prothrombin mutation with HELLP syndrome. FVL and G20210A prothrombin mutation were determined using PCR. Sixty-three pregnant women, 36 of them diagnosed with HELLP syndrome, were included in the study. Overall, 68 children were born as a result of these pregnancies and blood sampling was possible in 28 out of 39 children from HELLP patients and 25 out of 29 children from the control women. The prevalence of a maternal FVL was elevated 2-fold in HELLP patients compared with the control women [six out of 36 (16.7%) compared with two out of 27 (7.4%); P =0.282]. None of the HELLP patients and only one woman in the control group was found to be positive for the G20210A prothrombin mutation (P =0.251). The fetal carrier frequency was four out of 28 compared with three out of 25 for FVL (P =0.811), and two out of 28 compared with one out of 25 for G20210A prothrombin mutation (P =0.629). Intrauterine growth restriction (IUGR) was significantly higher in fetuses found to be positive for a thrombophilic mutation (P =0.022). IUGR occurred in seven out of ten fetuses with a thrombophilic mutation compared with 11 out of 43 in fetuses without a mutation. The prevalence of FVL, but not of the G20210A prothrombin mutation, seems to be elevated in women with HELLP syndrome. A fetal thrombophilic mutation does not contribute significantly to the clinical features of the HELLP syndrome. Our results demonstrate a fetal contribution to IUGR. Fetal thrombophilic mutations may lead to placental microthrombosis, which consecutively could lead to a disturbed fetoplacental blood flow and thus cause growth restriction.

Coagulation and prothrombotic state parameters: a clinical analysis during early pregnancy

“…A substantial increase in TXB2 can cause vasoconstriction, platelet aggregation, and thrombosis. If this occurs, thrombosis, fibrinoid necrosis, and atherosclerosis may be seen in the placenta and decidual vessels and can cause spontaneous abortion, preterm delivery, fetal distress, preeclampsia, and fetal growth restriction [10][11][12][13][14]. Studies of fetal growth restriction and preeclampsia performed with blood samples have reported an increase in TXB2 levels [15][16][17][18][19].…”

Prise en charge du HELLP syndrome

“…Il n'a cependant pas été démontré une corrélation significative entre le HELLP syndrome et la présence d'une thrombophilie qu'elle soit constitutionelle (mutations du facteur V Leiden et de la prothrombine) ou acquise (syndrome des anticorps antiphospholipides) [20][21][22][23][24] [27][28][29]. Toutefois, l'hypertension artérielle (HTA) et la protéinurie peuvent être initialement absentes (10 à 15 % des cas) et le diagnostic doit être évoqué devant des signes digestifs inhabituels au troisième trimestre [4,5,25,30].…”

Maternal Factor V Leiden Mutation Is Associated With HELLP Syndrome in Caucasian Women

“…Several studies have addressed the role of fetal inherited thrombophilias in pre-eclampsia, only three of them have included a small number of HELLP pregnancies (Table 5) (19,23,28,(33)(34)(35)(36)(37)(38). On the whole, there was no evidence for a strong association.…”

“…Previous association studies on thrombophilic genotypes and HELLP syndrome are summarized in Table 4 (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). Most of them were limited to a small sample size and genotyping was not done simultaneously for all of the three most common inherited thrombophilias.…”