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Fabregues F, Antonio García-Velasco J, Llácer J, Requena A, Ángel Checa M, Bellver J, José Espinós J. The role of thrombophilias in reproduction: A swot analysis. Eur J Obstet Gynecol Reprod Biol 2023; 280:12-21. [PMID: 36375360 DOI: 10.1016/j.ejogrb.2022.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/25/2022] [Indexed: 12/27/2022]
Abstract
Thrombophilia is a group of inherited or acquired coagulation disorders that have been associated with reproductive failure. However, there are still no clear recommendations on whether its inclusion in the initial study of the infertile couple or patients with recurrent implantation failure is necessary. In this discussion paper, based on a SWOT (strengths, weaknesses, opportunities, threats) analysis, the different aspects of the repercussions of thrombophilia screening and treatment in reproduction are evaluated. To avoid possible subjectivity in the analysis and results of this study, researchers followed Oxford criteria for the evaluation of evidence. The results from the evaluation of the reviewed bibliography seem to indicate that, pending new evidence, it would be advisable not to include thrombophilia screening in the initial baseline study of the infertile couple. There is no evidence to support a clear association between thrombophilia and implantation failure or infertility. Thrombophilia testing in this setting may increase cost, with minimal potential benefit and lead to inappropriate use of anticoagulants with possible deleterious adverse effects. Future well-designed studies are needed to assess the possible benefit of anticoagulant therapy in infertile thrombophilic patients with implantation failure.
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Affiliation(s)
- Francisco Fabregues
- Institut Clinic Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic, C/Villarroel 160, Barcelona 08036, Spain.
| | | | - Joaquín Llácer
- Ginefiv-GeneraLife, Calle José Silva 18, Madrid 28043, Spain
| | - Antonio Requena
- Ginefiv-GeneraLife, Calle José Silva 18, Madrid 28043, Spain
| | - Miguel Ángel Checa
- Hospital del Mar-Parc de Salut Mar, Paseo Maritimo 25-29, Barcelona 08005, Spain; Fundación Fertty, Ausiàs March 25, Barcelona 08010, Spain
| | - José Bellver
- Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Spain; Instituto Valenciano de Infertilidad (IVI-RMA) Valencia, Plaza de la Policía Local, 3, Valencia 46015, Spain; Fundación FIVI, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Juan José Espinós
- Fundación Fertty, Ausiàs March 25, Barcelona 08010, Spain; Universidad Autónoma de Barcelona. Campus de la UAB, Plaza Cívica, s/n, Bellaterra (Barcelona) 08193, Spain
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Factor V Leiden: Development of VTE in Surgery and Trauma Patients: A Systematic Review. Dimens Crit Care Nurs 2022; 41:190-199. [PMID: 35617583 DOI: 10.1097/dcc.0000000000000529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Factor V Leiden (FVL) is a hereditary thrombophilia, which causes the blood to be more hypercoagulable; in essence, the blood tends to clot more easily, especially under certain circumstances. It is the most common genetic mutation, causing thrombophilia in patients of white background. Patients that have FVL are at a higher risk to develop venous thromboembolism (VTE) after surgery and trauma. OBJECTIVE The purpose of this review is to identify FVL as a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer length of stay (LOS) in the hospital. METHODS This article is a systematic review of the literature involving research printed in peer-reviewed journals from 2015 to 2018. The University of Tennessee Health Science Center online library, PubMed, and Google Scholar were used for the literature search. RESULTS The results of this study determined that although FVL is in fact a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer LOS, management of VTE is no different for a person with FVL compared with those without FVL. CONCLUSION Factor V Leiden is a risk factor for the development of VTE, specifically deep vein thrombosis, in surgical, trauma, pregnant, and hormone replacement therapy patients, thus increasing LOS and recurrence of such events. Regardless of FVL status, management of VTE should be initiated promptly and discontinued when appropriate.
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Vicoveanu P, Vasilache IA, Scripcariu IS, Nemescu D, Carauleanu A, Vicoveanu D, Covali AR, Filip C, Socolov D. Use of a Feed-Forward Back Propagation Network for the Prediction of Small for Gestational Age Newborns in a Cohort of Pregnant Patients with Thrombophilia. Diagnostics (Basel) 2022; 12:diagnostics12041009. [PMID: 35454057 PMCID: PMC9025417 DOI: 10.3390/diagnostics12041009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 01/25/2023] Open
Abstract
(1) Background: Fetal growth restriction is a relatively common disorder in pregnant patients with thrombophilia. New artificial intelligence algorithms are a promising option for the prediction of adverse obstetrical outcomes. The aim of this study was to evaluate the predictive performance of a Feed-Forward Back Propagation Network (FFBPN) for the prediction of small for gestational age (SGA) newborns in a cohort of pregnant patients with thrombophilia. (2) Methods: This observational retrospective study included all pregnancies in women with thrombophilia who attended two tertiary maternity hospitals in Romania between January 2013 and December 2020. Bivariate associations of SGA and each predictor variable were evaluated. Clinical and paraclinical predictors were further included in a FFBPN, and its predictive performance was assessed. (3) Results: The model had an area under the curve (AUC) of 0.95, with a true positive rate of 86.7%, and a false discovery rate of 10.5%. The overall accuracy of our model was 90%. (4) Conclusion: This is the first study in the literature that evaluated the performance of a FFBPN for the prediction of pregnant patients with thrombophilia at a high risk of giving birth to SGA newborns, and its promising results could lead to a tailored prenatal management.
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Affiliation(s)
- Petronela Vicoveanu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.V.); (I.S.S.); (D.N.); (A.C.); (D.S.)
| | - Ingrid Andrada Vasilache
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.V.); (I.S.S.); (D.N.); (A.C.); (D.S.)
- Correspondence:
| | - Ioana Sadiye Scripcariu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.V.); (I.S.S.); (D.N.); (A.C.); (D.S.)
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.V.); (I.S.S.); (D.N.); (A.C.); (D.S.)
| | - Alexandru Carauleanu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.V.); (I.S.S.); (D.N.); (A.C.); (D.S.)
| | - Dragos Vicoveanu
- Faculty of Electrical Engineering and Computer Science, Stefan cel Mare University of Suceava, 720229 Suceava, Romania;
| | - Ana Roxana Covali
- Department of Radiology, Elena Doamna Obsterics and Gynecology University Hospital, 700398 Iasi, Romania;
| | - Catalina Filip
- Department of Vascular Surgery, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Demetra Socolov
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania; (P.V.); (I.S.S.); (D.N.); (A.C.); (D.S.)
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Mahmood S, Younas H, Younus A, Nathenial S. A narrative review on the role of folate-mediated one-carbon metabolism and its associated gene polymorphisms in posing risk to preeclampsia. Clin Exp Hypertens 2021; 43:487-504. [PMID: 34053381 DOI: 10.1080/10641963.2021.1916942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Preeclampsia (PE) presents a major obstetrical problem for mother and fetus which is characterized by the onset of hypertension and proteinuria in formerly normotensive women. Altered folate-mediated one-carbon metabolism is one of the factors for PE development either due to nutritional insufficiencies such as folate deficiency or polymorphisms in genes that code for the key enzymes of the cycle. Commonly, there are four genes in the cycle whose polymorphisms have been described in relation to PE. These factors could cause elevation of homocysteine; the toxic metabolite, which subsequently leads to the development of PE. Sufficient levels of folate have been considered important during pregnancy and may reduce the risk of development of PE. This review aims at discussing genetic polymorphisms and nutritional deficiencies as probable predisposing factors and suggests considering fetal genotypes, varied ethnicities, and interaction of various other factors involved to render better conclusiveness to the present studies.
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Affiliation(s)
- Sadia Mahmood
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
| | - Hooria Younas
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
| | - Amna Younus
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
| | - Sammar Nathenial
- Department of Biochemistry, Kinnaird College for Women, Lahore, Pakistan
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Voicu NL, Bohîlţea RE, Berceanu S, Busuioc CJ, Roşu GC, Paitici Ş, Istrate-Ofiţeru AM, Berceanu C, Diţescu D. Evaluation of placental vascularization in thrombophilia and intrauterine growth restriction (IUGR). ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2020; 61:465-476. [PMID: 33544798 PMCID: PMC7864309 DOI: 10.47162/rjme.61.2.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The placenta is an essential organ in the proper development of pregnancy, and it can present a lot of structural and vascular lesions that can affect fetal development. One of the pathologies associated with pregnancy, which can change the placental structure is thrombophilia (TPh), and this can be correlated with an intrauterine growth restriction (IUGR) of the fetus. Maternal clinical aspects (age, weight) can be correlated with fetal ones (weight, gender), but also with the structural and vascular aspect of the placenta. The placental structure associated with TPh and IUGR shows macroscopic changes, such as fibrin deposition, calcifications and placental infarctions, but microscopic lesions are best highlighted by classical staining techniques: Hematoxylin–Eosin (HE), Masson’s trichrome (MT) and Periodic Acid–Schiff (PAS)–Hematoxylin, but also by immunohistochemistry technique with the help of anti-cluster of differentiation 34 (CD34) antibody that could make it possible to quantify vascular density depending on the pathology. Microscopic changes were massive infarcts caused by vascular ischemia, intravenous and extravillous fibrin deposits, calcifications, and vascular thrombosis. All these clinical, morphological and morphopathological data are interconnected and may vary in the presence of TPh and IUGR.
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Affiliation(s)
- Nicoleta Loredana Voicu
- Department of Histology, Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Romania; ,
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Elzein HO, Saad AA, Yousif AA, Elamin E, Abdalhabib EK, Elzaki SEG. Evaluation of Factor V Leiden and prothrombin G20210A mutations in Sudanese women with severe preeclampsia. Curr Res Transl Med 2019; 68:77-80. [PMID: 31501046 DOI: 10.1016/j.retram.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 03/27/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Preeclampsia (PE) is a common pregnancy complication and one of the main causes of maternal and fetal morbidity and mortality, worldwide. While the pathogenesis of PE is unclear, it has been suggested that hypercoagulability due to Factor V Leiden (FVL) and prothrombin gene mutation (FII G20210A) play a role in its progression. PURPOSE This study aimed to determine if there is an association between FVL and FII G20210A mutations and severe PE. PATIENTS AND METHODS This case-control study enrolled 50 women with severe PE and 50 healthy pregnant women as the control, at Khartoum North Teaching Hospital, in Khartoum State, Sudan, from January 2017 to June 2017. The presence of point mutations in FVL and FII G20210A were determined for each of the participants. Deoxyribonucleic acid (DNA) was extracted, and then an allele-specific polymerase chain reaction (PCR) was used to detect the point mutations in FVL and FII G20210A. RESULTS The results revealed a significant difference between the subjects in the severe PE group and the control group for the means of parity, gestational age/ week and hemoglobin concentration (P < 0.05). No statistically significant body mass index (BMI) differences were found between the groups (P > 0.05). Women with severe PE were found to have a significant difference in FVL (16%; P value = 0.0058; OR: 20.20; 95%CI: 1.132-360.5) and FII G20210A (14%; P value = 0.0125; OR: 17.41; 95%CI: 0.9659-314.0) in comparison to the women in the control group (0%). CONCLUSION Our findings intensely indicate that there is a statistically proven significant association between FVL, FII G20210A mutations and the development of severe preeclampsia in Sudanese pregnant women.
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Affiliation(s)
- Husham O Elzein
- Department of Medical Laboratory, Faculty of Applied Medical Sciences, Northern Border University, Arar, Saudi Arabia.
| | - Alaa A Saad
- Faculty of Medical Laboratory Sciences, Al zaiem Al Azhari University, Khartoum, Sudan
| | - Alaa A Yousif
- Faculty of Medical Laboratory Sciences, Al zaiem Al Azhari University, Khartoum, Sudan
| | - Elwaleed Elamin
- Faculty of Medical Laboratory Sciences, Al zaiem Al Azhari University, Khartoum, Sudan
| | - Ezeldine K Abdalhabib
- Department of Clinical Laboratory Science, Faculty of Applied Medical Science, Qurayyat, Jouf University, Saudi Arabia
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Liu L, Yu Y, He J, Guo L, Li H, Teng J. Effects of MTHFR C677T and A1298C Polymorphisms on Migraine Susceptibility: A Meta‐Analysis of 26 Studies. Headache 2019; 59:891-905. [PMID: 31045246 DOI: 10.1111/head.13540] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Lijun Liu
- Department of Neurology Affiliated Hospital of Qingdao University Qingdao China
| | - Yongpeng Yu
- Department of Neurology, Center Hospital of Weihai, School of Medicine Qingdao University Weihai China
| | - Jian He
- Pharmacy Intravenous Admixture Services Affiliated Hospital of Qingdao University Qingdao China
| | - Lei Guo
- Department of Urology Affiliated Hospital of Qingdao University Qingdao China
| | - Hong Li
- Department of Neurology Affiliated Hospital of Qingdao University Qingdao China
| | - Jijun Teng
- Department of Neurology Affiliated Hospital of Qingdao University Qingdao China
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Li Y, Ruan Y. Association of hypertensive disorders of pregnancy risk and factor V Leiden mutation: A meta-analysis. J Obstet Gynaecol Res 2019; 45:1303-1310. [PMID: 31037802 DOI: 10.1111/jog.13976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/06/2019] [Indexed: 12/14/2022]
Abstract
AIM To date, the conclusions of studies on a possible association between factor V Leiden (FVL, FV G1691A, rs6025) and hypertensive disorders of pregnancy (HDP) are conflicting. Here, we aimed to estimate the relationship between the risk of HDP and FVL. METHODS Eligible studies focused on FVL and HDP were searched from the PubMed and the Web of Science databases up to March 31, 2018. We used random effects model for the meta-analysis, and I2 statistic to assess the degree of heterogeneity between all included studies. To evaluate the association between FVL and the risk of HDP, we calculated the odds ratio (OR) and 95% confidence intervals (CI) comparing cases and controls of all samples and each subgroup based on different regions. RESULTS Fifty citations on FVL and HDP were identified through the literature search, and a meta-analysis on the GA + AA genotype between 6041 cases and 8364 controls was conducted. The holistic analysis found that pregnant women with GA or AA genotype of FVL have a 1.97-fold (95% CI: 1.64-2.35, P < 0.00001) increased risk of HDP compared with GG carriers. While the OR are 2.23 (95% CI: 1.76-2.84, P < 0.00001) and 1.90 (95% CI: 1.12-3.23, P = 0.02) in Europe and the Middle East subgroups, respectively. CONCLUSION Factor V Leiden mutation is associated with an increased risk of HDP, and is particularly associated with preeclampsia and eclampsia in European women. However, further high-quality studies are warranted to confirm the possible effectiveness of FVL in HDP patients.
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Affiliation(s)
- Yuan Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yan Ruan
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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