Pregnancy complications in G20210A mutation carriers associated with high prothrombin activity

Abstract

Objective To study the association between high activity of Factor II (prothrombin) in blood plasma with G20210A mutation and the development of great obstetrical syndromes. Material and methods A prospective clinical cohort study was conducted on 290 pregnant women (average age 31.7 ± 4.7 years old). The main group was made up of 140 G20210A patients, while the control group comprised 150 women with the wild G20210G type. The aim was to evaluate the activity of Factor II in the venous blood plasma during the stages of pregnancy with regard to trophoblast invasion waves. As per results, association analysis of Factor II activity value and gestational complications was carried out. Results In the control group, the median (Me) of Factor II activity ranged from 108% (preconception period) to 144% (pregnancy) [95% CI 130–150]. In patients with the GA type, the value was significantly higher in related periods, ranging from 149 to 181% [95% CI 142–195], p < 0.0001. With Factor II activity ranging from 148.5 to 180.6%, pregnancies in the main group had no complications. Higher levels of Factor II activity were associated with the development of early and/or severe preeclampsia (PE) and fetal growth retardation (FGR). Conclusion The data obtained regarding Factor II activity in blood plasma, juxtaposed with the development of great obstetrical syndromes, allow to assume that manifestation of G20210A in early and/or severe PE and FGR is associated with this coagulation factor’s level of activity. Threshold value of the Factor II activity with G20210A mutation, allowing to predict the development of PE, comprised 171.0% at the preconception stage (AUC – 0.86; p < 0.0001) and within 7–8 weeks of gestation it was 181.3% (AUC – 0.84; p < 0.0001).

Assessment of the Particularities of Thrombophilia in the Management of Pregnant Women in the Western Part of Romania

“…Increased fibrin formation is linked to the PA1-1 4G/5G and may disrupt placenta circulation and implantation, potentially leading to pregnancy loss [ 20 ]. Pregnancy complications tested positive for the prothrombin G20210A mutation in 57.9% of patients [ 29 ] with an additional increased risk of early pregnancy loss and preterm placental abruption linked to the heterozygous GA variation [ 29 , 30 ].…”

Venous Thromboembolism in Pregnancy: Challenges and Solutions

“…It results in the overproduction of prothrombin, a precursor of thrombin, leading to thrombotic conditions, such as VTE and PE. 37 Deficiencies of Antithrombin, protein C, and protein S are ITs that are relatively rare but associated with a high risk of VTE during pregnancy and recurrent pregnancy loss. 35 , 38 Antithrombin is a natural anticoagulant that inhibits thrombin and other coagulation factors, while protein C and protein S are cofactors in the inactivation of coagulation factors.…”

Advisory Board conclusion following the discussion "Controversial issues of low molecular weight heparins use in obstetrics"

“…Однако наиболее значимый прогноз риска определен в случае проявленности лабораторного фенотипа. Так, при показателе APC-R ≤ 0,49 по НО у носителей мутации Лейден риск развития ПАО увеличивается в 6,6 раза (RR = 6,6; 95 % Cl = 2,6-14,1; р = 0,0001), при показателе активности протромбина больше 180 % у носителей мутации в гене фактора II -в 5,2 раза (RR = 5,2; 95 % Cl = 2,9-10,2; р = 0,0001) [22]. Также определена корреляционная связь умеренной силы между активностью протромбина (прямая) и резистентностью фактора Vа к активированному протеину С (обратная) с показателем эндогенный тромбиновый потенциал в тесте генерации тромбина.…”