TY - JOUR
T1 - The association of factor V leiden and prothrombin gene mutation and placenta-mediated pregnancy complications
T2 - A systematic review and meta-analysis of prospective cohort studies
AU - Rodger, Marc A.
AU - Betancourt, Marisol T.
AU - Clark, Peter
AU - Lindqvist, Pelle G.
AU - Dizon-Townson, Donna
AU - Said, Joanne
AU - Seligsohn, Uri
AU - Carrier, Marc
AU - Salomon, Ophira
AU - Greer, Ian A.
N1 - Funding Information:
MAR is the principal investigator of a Canadian Institutes of Health Research randomised trial comparing dalteparin to no dalteparin to prevent placenta-mediated pregnancy complications in thrombophilic women. MAR has received grant funding from Pfizer, Sanofi, Boehringer Ingelheim, Bayer, GTC Therapeutics, and Leo Pharma. MAR has also served on advisory boards for Boehringer Ingelheim and Biomerieux but not been paid. IAG has received Honoraria for lectures and advisory boards from Sanofi Aventis and Leo Pharma.
PY - 2010/6
Y1 - 2010/6
N2 - Background: Factor V Leiden (FVL) and prothrombin gene mutation (PGM) are common inherited thrombophilias. Retrospective studies variably suggest a link between maternal FVL/PGM and placenta-mediated pregnancy complications including pregnancy loss, small for gestational age, pre-eclampsia and placental abruption. Prospective cohort studies provide a superior methodologic design but require larger sample sizes to detect important effects. We undertook a systematic review and a meta-analysis of prospective cohort studies to estimate the association of maternal FVL or PGM carrier status and placenta-mediated pregnancy complications. Methods and Findings: A comprehensive search strategy was run in Medline and Embase. Inclusion criteria were: (1) prospective cohort design; (2) clearly defined outcomes including one of the following: pregnancy loss, small for gestational age, pre-eclampsia or placental abruption; (3) maternal FVL or PGM carrier status; (4) sufficient data for calculation of odds ratios (ORs). We identified 322 titles, reviewed 30 articles for inclusion and exclusion criteria, and included ten studies in the meta-analysis. The odds of pregnancy loss in women with FVL (absolute risk 4.2%) was 52% higher (OR= 1.52, 95% confidence interval [CI] 1.06-2.19) as compared with women without FVL (absolute risk 3.2%). There was no significant association between FVL and pre-eclampsia (OR=1.23, 95% CI 0.89-1.70) or between FVL and SGA (OR=1.0, 95% CI 0.80-1.25). PGM was not associated with pre-eclampsia (OR =1.25, 95% CI 0.79-1.99) or SGA (OR 1.25, 95% CI 0.92-1.70). Conclusions: Women with FVL appear to be at a small absolute increased risk of late pregnancy loss. Women with FVL and PGM appear not to be at increased risk of pre-eclampsia or birth of SGA infants.
AB - Background: Factor V Leiden (FVL) and prothrombin gene mutation (PGM) are common inherited thrombophilias. Retrospective studies variably suggest a link between maternal FVL/PGM and placenta-mediated pregnancy complications including pregnancy loss, small for gestational age, pre-eclampsia and placental abruption. Prospective cohort studies provide a superior methodologic design but require larger sample sizes to detect important effects. We undertook a systematic review and a meta-analysis of prospective cohort studies to estimate the association of maternal FVL or PGM carrier status and placenta-mediated pregnancy complications. Methods and Findings: A comprehensive search strategy was run in Medline and Embase. Inclusion criteria were: (1) prospective cohort design; (2) clearly defined outcomes including one of the following: pregnancy loss, small for gestational age, pre-eclampsia or placental abruption; (3) maternal FVL or PGM carrier status; (4) sufficient data for calculation of odds ratios (ORs). We identified 322 titles, reviewed 30 articles for inclusion and exclusion criteria, and included ten studies in the meta-analysis. The odds of pregnancy loss in women with FVL (absolute risk 4.2%) was 52% higher (OR= 1.52, 95% confidence interval [CI] 1.06-2.19) as compared with women without FVL (absolute risk 3.2%). There was no significant association between FVL and pre-eclampsia (OR=1.23, 95% CI 0.89-1.70) or between FVL and SGA (OR=1.0, 95% CI 0.80-1.25). PGM was not associated with pre-eclampsia (OR =1.25, 95% CI 0.79-1.99) or SGA (OR 1.25, 95% CI 0.92-1.70). Conclusions: Women with FVL appear to be at a small absolute increased risk of late pregnancy loss. Women with FVL and PGM appear not to be at increased risk of pre-eclampsia or birth of SGA infants.
UR - http://www.scopus.com/inward/record.url?scp=77955027422&partnerID=8YFLogxK
U2 - 10.1371/journal.pmed.1000292
DO - 10.1371/journal.pmed.1000292
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AN - SCOPUS:77955027422
SN - 1549-1277
VL - 7
JO - PLoS Medicine
JF - PLoS Medicine
IS - 6
ER -
