|
Middle East Fertility Society Journal
Middle East Fertility Society
ISSN: 1110-5690
Vol. 12, Num. 3, 2007, pp. 179-183
|
Middle
East
Fertility
Society
Journal,
Vol.
12,
No.
3,
2007,
pp.
179-183
Prevalence
of
factor
V
Leiden
mutation
and
its
relation
with
recurrent
spontaneous
pregnancy
loss
in
a
group
of
Syrian
women
Mohammad
Motee
Abbas
Mohammad *,Marwan
Gamil
Al-Halabi,
Ph.D. ,Fawza
Mohammad
Sharif
Monem,
PhD.
Faculty
of
Pharmacy,
and
faculty
of
Medicine
Damascus
University,
Damascus,
Syriaz
*Correspondence:
Mohammad
Motee
Mohammad,
Faculty
of
pharmacy,
Damascus
University,
Syria,
Tel:
+963933236013,
E-mail:
m_motee@hotmail.com.
Master
in
Laboratory
Diagnosis.
† Assistant
Professor
in
faculty
of
Medicine.
Damascus
University.
Head
of
Orient
Hospital
for
obstetrics,
gynecology
and
assisted
reproduction.
Damascus.
Syria.
‡ Professor
in
faculty
of
Pharmacy.
Head
of
Laboratories
of
Al-Assad
University
Hospital.
Damascus
University.
Syria.
Received
on
January
29,
2007;
revised
and
accepted
on
September
2,
2007
Code
Number:
mf07034
ABSTRACT
Objective: The
aim
of
our
study
was
to
investigate
the
prevalence
of
factor
V
Leiden
and
its
relation
with
RPL
in
a
group
of
Syrian
women.
Materials
and
Methods: The
study
group
included
35
women
with
a
history
of
recurrent
pregnancy
loss
(two
or
more
abortions
before
20th
week
of
gestation)
were
referred
to
Orient
hospital
for
obstetrics,
gynecology
and
assisted
reproduction,
Damascus,
Syria,
for
investigation
between
December
2005
and
July
2006.
All
women
with
known
causes
of
pregnancy
loss
after
convenient
investigations
were
excluded.
The
control
group
included
45
healthy
women
from
the
same
ethnic
background,
who
had
at
least
one
successful
pregnancy,
and
none
of
them
had
a
history
of
fetal
loss
or
complicated
pregnancy.
FVL
mutation
was
screened
by
Real-time
PCR
method.
Results: The
results
show
that
10
women
out
of
35
with
RPL
and
4
women
out
of
45
controls
had
FVL
mutation
(28.6
versus
8.9
%,P=0.022,
Odds
ratio
4.1,
95%
CI:
1.16-14.4).
From
the
25
women
who
were
primary
RPL,
eight
patients
had
the
factor
V
Leiden
(32
versus
8.9%,
P=0.014,
OR:
4.8,
95%CI:
1.2,
18.17).
From
the
10
women
who
were
secondary
RPL,
two
patients
had
the
factor
V
Leiden
(20
versus
8.9%,
P=0.30,
OR:
2.5,
95%
CI:
0.4-16.4).
All
patients
and
controls
carrying
the
factor
V
Leiden
were
heterozygote.
Conclusion: Our
results
revealed
that
the
prevalence
of
FVL
was
significantly
higher
in
women
with
RPL
in
comparison
with
controls,
particularly
in
the
subgroup
with
primary
RPL,
and
there
is
an
association
between
factor
V
Leiden
mutation
and
recurrent
pregnancy
loss.
Key
Words: Factor
V
Leiden
mutation,
recurrent
pregnancy
loss,
Prevalence,
Syrian
women
Recurrent
pregnancy
loss
(RPL)
is
a
complex
problem
and
a
more
frequent
condition
in
obstetric
practice.
It
affects
about
5%
of
pregnant
women
when
defined
as
two
or
more
consecutive
spontaneous
of
fetal
losses
(1).
Although
some
cases
of
RPL
are
due
to
known
causes
such
as
congenital uterine malformations, chromosomal
abnormalities,
systemic
diseases
and
endocrine
factors
(2),
up
to
50%
of
all
cases remain
with
unknown
causes
(3).
Maternal
thrombophilia
such
as
activated
protein
C
resistance
may
be
a
possible
cause
of RPL
(2,3).
Activated
protein
C
resistance
(APC)
is
the
most
frequent
thrombophilic
defect
associated
with
venous
thrombosis
(4).
More
than
95%
of
the
APC
resistance
phenotype
can
be
explained
by
the
factor
V
Leiden
(FVL)
mutation.
This
defect
is
caused
by
a
single
point
mutation
(G-A)
at
nucleotide
position
1691
in
the
factor
V
gene
resulting
in
a
replacement
of
Arg
by
Glu
residue
(5).
The
new
form
of
factor
V
has
the
same
procoagulant
activity
of
the
normal
factor
V,
but
it
is
resistant
to
APC
degradation
resulting
in
an
increased
thrombin
generation
and
hypercoagulable
state
(6).
The
FVL
mutation
is
found
in
4
-10
%
in
Caucasians
and
the
risk
of
venous
thrombosis
increase
seven
times
in
heterozygote
and
eighty
times
in
homozygote
carriers
compared
to
non-carriers
(7).
Recently,
several
studies
suggested
that
FVL
mutation,
through
production
of
microthrombosis
on
placental
bed
vessels
and
placental
infractions
which
result
in
low
placental
perfusion,
was
strongly
associated
with
RPL
(8-0).
Conversely,
other
studies
failed
to
demonstrate
any
association
between
FVL
mutation
and
RPL
(11-13).
In
view
of
the
high
prevalence
of
FVL
mutation
among
healthy
population
in
countries
of
the
Eastern
Mediterranean,
in
Lebanon
(14.4%),
in
Syria
(13.6%)
in
Greece-Cyprus
(13.4%),
and
Jordan
(12.3%)
(14),
and
the
lack
of
data
on
the
possible
role
of
FVL
mutation
in
RPL
in
Syria,
our
study
aimed
to
determine
the
prevalence
of
factor
V
Leiden
and
its
relation
in
a
group
of
Syrian
women
with
recurrent
pregnancy
loss.
MATERIALS
AND
METHODS
The
study
group
included
35
women
(mean±SD:29.6±6.3
years,
range16-42
years)
with
a
history
of
RPL
(two
or
more
abortions
before
20th
week
of
gestation,
mean±SD:4±2.31,
range
2-11)
who
referred
to
Orient
hospital
and
assisted
reproduction
center,
Damascus,
Syria,
for
investigation
between
September
2005
and
July
2006.
All
women
with
known
independent
risk
factor
for
pregnancy
complication,
such
as
uterine
malformation,
systemic
disease
(Diabetes
mellitus,
Lupus
erythematosus),
endocrine
abnormality
(Prolactin,
Thyroid
Stimulating
Hormone,
Follicular
Stimulating
Hormone
and
Luteal
Hormone
during
the
early
follicular
phase),
and
women
who
received
induced
abortion
upon
their
request
were
excluded,
in
addition
to
the
women
with
other
thrombophilic
defects,
such
as
antiphospholipid
antibodies
syndrome
(Lupus
anticoagulant,
Anticardiolpin),
or
deficiency
of
activities
of
antithrombin
III,
protein
C,
and
protein
S.
On
one
hand,
twenty-five
patients
were
with
primary
RPL
(they
had
never
delivered
a
viable
fetus),
and
10
patients
were
with
secondary
RPL
(they
had
delivered
a
viable
fetus
and
then
experienced
recurrent
pregnancy
loss).
On
the
other
hand,
seven
patients
had
two
miscarriages,
12
had
three,
and
16
had
more
than
three.
The
control
group
included
45
healthy
women
(mean ± SD:
28.8±6.8
years,
range
17-41
years)
from
the
same
ethnic
background,
who
had
at
least
one
successful
pregnancy,
and
none
of
them
had
a
history
of
fetal
loss
or
complicated
pregnancy.
No
woman
in
this
study
had
a
personal
or
family
history
of
thrombosis.
The
study
was
approved
by
the
ethics
committee
of
the
hospital
and
written
informed
consent
was
obtained
from
each
woman.
Venous
blood
sample
was
collected
from
each
woman
into
EDTA
containing
vacutainer
tubes.
The
DNA
was
isolated
from
whole
blood
within
5
days
after
the
sample
collection
using
the
Wizard® Genomic
DNA
purification
kit
(cat.#
A1125,
Promega,
USA),
as
described
by
the
manufacturer.
The
purified
DNA
was
stored
at
-20oC
until
assay
time.
Aliquots
of
DNA
were
used
for
screening
FVL
mutation
by
Real-Time
PCR
using
light
Cycler® 1.2
Instrument
and
the
Roche
light-Cycler
mutation
detection
kits
for
FVL
(Roche
Diagnostics
GmbH,
Germany)
according
to
the
method
described
and
provided
with
the
kit
by
the
manufacturer.
Statistical
analysis
was
performed
on
SPSS
v.10
statistics
software.
Data
were
expressed
as
percentages.
Chi-square
test
and
student's
t-test
were
used
to
asses
inter
group
significance.
In
addition,
The
Odds
Ratio
(OR)
was
used
as
a
measure
of
the
risk
factor
of
RPL
and
95%
confidence
intervals
(CI)
were
calculated
by
standard
methods.
Statistical
significance
was
set
at
P < 0.05.
RESULTS
Characteristics
and
outcome
of
previous
pregnancies
of
the
patients
and
controls
are
shown
in
Table
1. Characteristics
of
patients
and
controls.
Characteristic
|
Patients
(n=35)
|
Control(n=45)
|
P
value
|
|
|
|
|
Age
mean ± SD
(range)
|
29.6±6.3
(16-42)
|
28.8±6.8
(17-41)
|
0.56a
|
Pregnancies
|
|
|
|
Total
number*
|
158
|
113
|
<0.001
|
No.
of
live
births
|
15
|
113
|
|
Mean ± SD
(range)
|
0.42 ±0.73
(0-2)08
|
2.5 ±1.08
(1-5)
|
|
No.
of
fetal
losses
|
143
|
-
|
|
Mean ± SD
(range)
|
4± 2.31
(2-11)
|
|
|
Type
of
abortion
|
|
|
|
Primary
|
25
|
|
|
Secondary
|
10
|
|
|
a Students
t-test
(2-tailed)
b Pearson's X2 test
* Total
number
=
live
births
+
fetal
losses
Primary
=
patient
had
never
live
births
Secondary
=
patients
had
at
least
one
live
births
Table
1.
Both
patients
and
controls
had
a
similar
age.
There
was
no
significant
difference
between
patients
and
controls
in
the
pregnancy
rate.
The
mean
number
of
live
births
per
women
was
significantly
higher
among
controls
(P <0.001).
The
results
of
screening
FVL
mutation
in
patients
and
controls
are
given
in
Table
2.The
women
with
RPL
had
a
significantly
higher
frequency
of
FVL
mutation
than
did
the
control
(P=
0.022).
Further,
the
higher
prevalence
of
FVL
mutation
was
found
in
women
with
primary
RPL
in
comparison
with
controls
(P=
0.014).
While,
the
higher
prevalence
of
FVL
mutation
was
found
in
women
with
secondary
RPL
in
comparison
with
controls,
but
this
prevalence
did
not
reach
significance
in
comparison
with
controls
(P=0.30).
All
patients
and
controls
carrying
factor
V
Leiden
mutation
were
heterozygote.
DISCUSSION
The
fate
of
fetus
is
highly
affected
by
the
placental
development
and
function,
which,
in
turn
depend
upon
the
development
of
an
adequate
maternal-fetal
circulation
(15).
Table
2. Factor
V
Leiden
(FVL)
mutation
in
patients
with
recurrent
pregnancy
loss
and
in
control
|
Patients
|
Control
|
OR
(CI) a
|
p-value b
|
|
|
|
|
|
RPL * (n=35)
|
|
|
4.1 (1.16-14.4)
|
0.022
|
Non
carrier
(G/G)
|
25(71.4 )
|
41
(91.1)
|
|
|
Carrier (G/A)
|
10
(
28.6)
|
4
(8.9)
|
|
|
Primary RPL
(n=25)
|
|
|
4.8
(1.2-18.17)
|
0.014
|
Non-carrier(G/G)
|
17
(68)
|
41
(91.1)
|
|
|
Carrier(G/A)
|
8 (32)
|
4
(8.9)
|
|
|
Secondary§ RPL
(n=10)
|
|
|
2.5
(0.4-16.4)
|
0.30
|
Non-carrier(G/G)
|
8
(80)
|
41(91.1)
|
|
|
Carrier
(G/A)
|
2
(20)
|
4(8.9)
|
|
|
a OR=
odds
ratio;
CI=
95%
confidence
interval
b Pearson's X2 test.
* RPL=recurrent
pregnancy
loss
G/G:
wild-type
factor
V
gene;
G/A=
heterozygous
factor
V-Leiden
mutation.
Primary
=
patient
had
never
live
births
§ Secondary
=
patients
had
at
least
one
live
births
Values
in
brackets
are
percentages
A
maternal
thrombophilia
caused
by
factor
V
Leiden
mutation
may
result
in
production
of
microthrombosis
on
placental
bed
vessels
and
placental
infractions,
which
damage
the
maternal
vessels
supplying
the
placenta
(the
spiral
arteries)
leading
to
low
placental
perfusion
and
eventually
in
fetal
death,
or
may
interfere
with
initial
formation
of
an
adequate
uteroplacental
circulation.
Our
results
documented
a
clear
association
between
FVL
mutation
and
RPL
(OR:
4.1).
The
prevalence
of
FVL
was
significantly
higher
in
women
with
RPL
in
comparison
with
controls
(P=0.022).
This
result
agrees
with
those
reported
by
Mitraui
N
et
al.
(8),
Finan
RR
et
al
(9),
and
Mahjoub
et
al.
(10).
Conversely,
this
result
objected
with
those
reported
by
Zahed
et
al.
(11),
Alfirevic
et
al.
(12),
and
Howard
et
al
(13)
who
found
no
correlation
between
FVL
mutation
and
RPL.
Also,
Pauer
et
al.
(16)
reported
that
the
prevalence
of
FVL
mutation
was
similar
between
patient
and
control
group.
This
conflict
in
the
results
reported
by
different
studies
may
be
due
to
different
approaches
in
addressing
the
subject
such
as,
number
of
abortions
(11),
to
bias
in
patients
selection
(16),
and
ethnic
heterogeneity
among
the
patients
(13).
It
is
of
interest
to
note
that the
FVL
mutation
constitutes
a
major
risk
factor
if
Primary
RPL
is
considered
in
comparison
with
control
(OR:4.8),
while
the
FVL
mutation
constitute
a
minor
risk
factor
if
secondary
RPL
is
considered
in
comparison
with
control
(OR:
2.5).
Also,
the
prevalence
of
FVL
mutation
was
more
prominent
in
women
with
primary
RPL
in
comparison
with
control,
and
the
deference
was
statistically
significant
(P=0.014),
Our
results
agree
with
those
reported
by
Wramsby
et
al
(17)
and
Finan
et
al
(9),
who
reported
a
high
frequency
of
FVL
mutation
in
women
with
primary
RPL
in
comparison
control.
While
the
prevalence
of
FVL
mutation
was
prominent
in
women
with
secondary
RPL
in
comparison
with
control,
but
the
deference
was
not
statically
significant
(P=0.3).
Consequently,
if
this
result
doesn't
appear
compatible
with
the
hypothesis
that
FVL
mutation
may
play
in
some
cases
of
secondary
RPL,
this,
perhaps,
may
be
due
to
the
small
number
of
this
subgroup.
According
to
our
knowledge,
this
is
the
first
report
highlighted
the
role
of
FVL
mutation
in
RPL
in
Syrian
population.
In
conclusion,
our
data
support
the
hypothesis
that
thrombophilia
caused
by
FVL
mutation
may
plays
a
role
in
the
pathophysiology
of
primary
recurrent
abortion,
and
the
investigation
of
FVL
mutation
should
be
routinely
in
women
with
recurrent
pregnancy
loss.
REFERENCES
-
Regan
L,
Rai
R
.Thrombophilia
and
pregnancy
loss.
J
Reprod
Immunol
2002;
55:163-180.
-
Speroff
L,
Fritz
MA,
Recurrent
pregnancy
loss.
In: Speroff
L,
Fritz
MA,
editors.
Clinical
Gynecologic Endocrinology
and
Infertility.
7th
ed.
Philadelphia:
Lippincot
William& Wilkins,
2005:1069-1101.
-
Goldman J
C,
Nakhuda
G
S,
Zimmerman
R
C,
Sauer
MV,
The
role
of
factor
V
Leiden
mutation
in
recurrent
pregnancy
loss,
JAMWA
2003;
58:165-172.
-
Svensson
P
J,
Dahl
back
B.
Resistance
to
Activated
Protein
C
as
a
Basis
for
Venous
Thrombosis.
N
Engl
J
Med
1994;
330:517-522.
-
Bertina
R,
Koelman
B,
Koster
T,
Rosendale
F,
Dirven
R,
de
Ronde
H
et
al.
Mutation
in
blood
coagulation
factor
V
associated
with
resistance
to
activated
protein
C.
Nature1994;
369:64-67.
-
Sottiltta
G,
Oriana
V,
Latella
C,
Luise
F,
Piromalli
A,
Ramirez
F
et
al.
Genetic
prothrombotic
risk
factors
in
women
with
unexplained
pregnancy
loss.
Thrombosis
Research
2006;
117:681-684.
-
Van
Dunne
F
M,
de
Craen
A
J,
Heijmans
B
T,
Helmerhorst
F
M,
westendorp
RG.
Gender-specific
association
of
the
factor
V
Leiden
mutation
with
fertility
and
fecundity
in
a
histories
cohort.
The
Leiden
85-plus
study.
Hum
Reprod
2006;
21:967-971.
-
Mitraui
N,
Borgi
L,
Hizem
S,
Nsiri
B,
Finan
RR,
Gris
J
C
et
al
.Prevalence
of
antiphospholipid antibodies,
factor
V
G1691A
(Leiden
)
and
prothrombin
G20210A
mutations
in
early
and
late
recurrent
pregnancy
loss.
Euro
J
Obstet Gynecol
and
Reprod
Biology
2005;119:164-170.
-
Finan
RR,
Tamim
H,
Ameen
G,
Sharida
HE,
Rashid
M,
Almawi
Y
W.
Prevalence
of
factor
VG1691A
(factor
V-Leiden
)
and
Prothrombin
G20210A
gene
mutation
in
a
recurrent
miscarriage
population.
Am
J
Hematology
2002;
71:300-305.
-
Mahjoub
T,
Mtiraoui
N,
Tamim
H,
Hizem
S,
Finan
RR,
Nsiri
B,
Almawi
WY.
Association
between
adverse
pregnancy
outcomes
and
maternal
factor
V
G1691A
(Leiden)
and
prothrombin
G20210A
genotypes
in
women
with
a
history
of
recurrent
idiopathic
miscarriages.
Am
J
Hematol.
2005
Sep;80(1):9-12.
-
Zahed
LF,
Rayes
RF,
Mahfouz
RA,
Taher
AT,
Maarouf
HH,
Nassar
AH.
Prevalence
of
factor
V
Leiden,
prothrombin
and
methylene
tetrahydrofolate
reductase
mutations
in
women
with
adverse
pregnancy
outcomes
in
Lebanon.
Am
J
Obstet
Gynecol.
2006
Oct;195(4):1114-1118.
-
Alfirevic
Z,
Mousa
HA,
Martlew
V,
Briscoel
L,
Perezcasol
M,
Toh
CH.
Postnatal
screening
for
thrombophilia
in
women
with
sever
pregnancy
complications
.Obstet
Gynecol
2001;97:753-759.
-
Howard
C,
Ophira
S
,Daniel
S
,Rim
D,
Nurith
R,
Aida
I.
prevalence
of
genetic
markers
for
thrombophilia
in
recurrent
pregnancy
loss.
Hum
Reprod
2002:6;
1633-1637.
-
Hakime
N,
Tamim
H,
Kreidy
R,
Almawi
W.
The
Prevalence
of
factor
R506Q
mutation-Leiden
among
apparently
healthy
Lebanese.
Am
J
Hematology
2000;
65:45-49.
-
Greer
AI.
Thrombophilia
:implications
for
pregnancy
outcome
.
thrombosis
research
.2003:109;73-81.
-
Pauer
HU,
Voigt-Tschirschwitz
T,
Hinney
B,
Burfeind
P,
Wolf
C,
Emons
G
et
al.
Analyzes
of
three
common
thrombophilic
gene
mutations
in
German
women
with
recurrent
abortions.
Am
J
Obstet
Gynecol
2003;
Oct;
82(10):942-947.
-
Wramsby
ML
,
Sten-linder
M,
Bremme
K.
primary
habitual
abortions
are
associated
with
high
frequency
of
factor
V
Leiden
mutation
.fertility
and
sterility
.2000:74
(5):987-991.
The
study
was
financial
supported
by
faculty
of
pharmacy,
Damascus
University
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