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CMAJ • July 9, 2002; 167 (1)
© 2002 Canadian Medical Association or its licensors

Review
Synthèse

The effect of factor V Leiden carriage on maternal and fetal health

Dena Bloomenthal*, Peter von Dadelszen*, Robert Liston*, Laura Magee{dagger} and Peter Tsang{ddagger}

From *the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology; {dagger}the Division of Specialised Women's Health, Department of Internal Medicine; and {ddagger}the Division of Hematology, Department of Medicine, University of British Columbia and the Children's and Women's Health Centre of British Columbia, Vancouver, BC

Correspondence to: Dr. Dena Bloomenthal, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of British Columbia, 1T62-4500 Oak St., Vancouver BC V6H 3N1; fax 604 875-3864; dbloomenthal{at}cw.bc.ca

Abstract

FACTOR V LEIDEN IS A COMMON GENETIC MUTATION that predisposes its carriers to venous thromboembolism. When combined with the hypercoagulable state that is characteristic of pregnancy, there is an increased risk of severe and recurrent pregnancy complications. Factor V Leiden is the most common cause of primary and recurrent venous thromboembolism in pregnancy. Factor V Leiden carriage has consistently been shown to increase the risk of early onset gestational hypertension and HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) in pregnancy. Maternal carriage of factor V Leiden is also associated with severe placental abruption and fetal growth disturbances. Although it is unclear whether factor V Leiden causes an increased risk of first trimester miscarriage, it is associated with stillbirth and placental infarction. Patients with venous thromboembolism or severe pregnancy complications should be tested for factor V Leiden and other inherited and acquired thrombophilia. Therapeutic heparin is required for acute thromboembolic events in pregnancy. Patients with factor V Leiden and a previous venous thromboembolism may, according to their level of risk, be offered either prophylactic or therapeutic heparin. The role of antithrombotic therapy in the prevention of severe pregnancy complications remains unclear.




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Survival advantage of Factor V Leiden is now tested!
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