High prevalence of the prothrombin gene mutation in women with intrauterine growth retardation, abruptio placentae and second trimester loss

Abstract

Our data demonstrate that the mutation in the prothrombin gene is associated with specific pregnancy complications.

Thrombophilia and pregnancy

“…In this study, which was the first to examine the prothrombin mutation in women with pregnancy complications, the OR for this mutation was 8.9; 95% CI 1.8–43.6, whereas the OR for FV Leiden mutation were 4.9; CI 1.-17.4, and for MTHFR mutation the OR was 2; CI 0.5–8.1. In another study [63], the rate of the prothrombin mutation in 27 women with abruptio placentae was 18.5% compared to 3.2% in controls (OR 5.8; 95% CI 1.8–18.6), P = 0.01. In the study of de Vries et al [89] abruptio placentae was associated with 26% hyperhomocysteinemia and 29% protein S deficiency.…”

“…The prothrombin mutation was found in only one family of the 34 tested and was similar in cases and controls. Kupferminc et al [63] tested for the prothrombin mutation 222 patients with: severe preeclampsia (n = 55), mild preeclampsia (n = 25), and other complications and also 156 healthy women. Twenty eight (13%) were heterozygotes of the prothrombin mutation compared to 5 (3.2%) of the controls (p = 0.001).…”

“…[86-88] Several studies albeit small, showed that in multiparous women with thrombophilias and severe pregnancy complications there is high (66–83%) recurrence rate in subsequent pregnancies, while the type of complication may change from one pregnancy to the other; e.g. severe preeclampsia to IUGR [47,58,59,63]. …”

“…The women with obstetric complications had also significantly higher incidence of combined thrombophilias. Kupferminc et al [63], in another study, tested the prothrombin mutation in patients with severe preeclampsia (n = 55), mild preeclampsia (n = 25), IUGR defined as birtweight below the 10 th percentile (n = 72), severe abruptio placentae (n = 27), unexplained stillbirth > 23 weeks' gestation (n = 16), second trimester fetal loss, three or more consecutive first trimester losses and 156 healthy control women who had at least one normal pregnancy. Twenty-eight women of the study group (13%) were found to be heterozygous carriers of the 20210 variant of the prothrombin gene compared to five (3.2%) of the control group (p = 0.001, OR 2.9; 95% CI 1.3–6.5).…”

Management of fetal growth restriction

“…1 It is surprisingly common, with placental dysfunction occurring in about 3% of pregnancies, and despite advances in obstetric care, FGR remains a major problem in developed countries. 2 In human pregnancies, placental insufficiency is the leading cause of FGR and is usually due to poor uteroplacental blood flow and placental infarcts. The reduction of placental supply of nutrients to the fetus 3 has been associated with several adaptive changes taking place in both the placenta and fetus.…”