Correspondence |
Factor V Leiden, pregnancy complications and adverse outcomes
Sir,In their recent paper, Nurk et al. nicely demonstrated an association between maternal factor V Leiden (FVL) mutation and pregnancy complications.1 In addition, maternal smoking and the methylenetetrahydrofolate reductase (MTHFR) 677CT/TT genotype further increased the risk of stillbirth in mothers with FVL mutation. In another recent study,2 Coulam et al. compared the prevalences of ten thrombophilic gene mutations (including FVL, MTHFR C677T, MTHFR A1298C and factor II G20210A) in 150 women with a history of recurrent miscarriage vs. a control group of fertile women with no history of miscarriage. The prevalence of homozygous mutations and total gene mutations, rather than the frequency of specific gene mutations, was significantly higher in the recurrent miscarriage group. These results suggest that complex interactions between a number of fairly common thrombophilic gene mutations are contributing to the multifactorial aetiology of placental insufficiency. As the factor II G20210A mutation is common, with a prevalence of approximately 1.7% in Northern Europe,3 and has also been implicated as a contributory factor in obstetric complications,4 it would be interesting to know why Nurk et al. chose not to examine the possible association of factor II G20210A mutation with pregnancy complications in their large retrospective cohort and, in particular, its possible interactions with some of the other measured risk factors such as MTHFR polymorphisms and cigarette smoking.
P.T. Murphy
Department of Haematology
Beaumont Hospital
Dublin
Ireland
email: philipmurphy{at}beaumont.ie
References
1. Nurk E, Tell GS, Refsum H, Ueland PM, Vollset SE. Factor V Leiden, pregnancy complications and adverse outcomes: the Hordaland Homocysteine Study. Q J Med 2006; 99:289–98.
2. Coulam CB, Jeyendran RS, Fishel LA, Roussev R. Multiple thrombophilic gene mutations rather than specific gene mutations are risk factors for recurrent miscarriage. Am J Reprod Immunol 2006; 55:360–8.
3. Rosendaal FR, Doggen CJ, Zivelin A, Arruda VR, Aiach M, Siscovick DS, et al. Geographic distribution of the 20210 G to A prothrombin variant. Thromb Haemost 1998; 79:706–8.[Web of Science][Medline]
4. Grandone E, Margaglione M, Colaizzo D, Pavone G, Paladini D, Martinelli P, et al. Lower birth-weight in neonates of mothers carrying factor V G1691A and factor II A20210 mutations. Haematologica 2002; 87:177–81.
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