The GOAL study: A prospective examination of the impact of factor V Leiden and ABO(H) blood groups on haemorrhagic and thrombotic pregnancy outcomes

Department of Transfusion Medicine, Ninewells Hospital and Medical School, Dundee, UK.
British Journal of Haematology (Impact Factor: 4.71). 01/2008; 140(2):236-40. DOI: 10.1111/j.1365-2141.2007.06902.x
Source: PubMed


Factor V Leiden (FVL) and ABO(H) blood groups are the common influences on haemostasis and retrospective studies have linked FVL with pregnancy complications. However, only one sizeable prospective examination has taken place. As a result, neither the impact of FVL in unselected subjects, any interaction with ABO(H) in pregnancy, nor the utility of screening for FVL is defined. A prospective study of 4250 unselected pregnancies was carried out. A venous thromboembolism (VTE) rate of 1.23/1000 was observed, but no significant association between FVL and pre-eclampsia, intra-uterine growth restriction or pregnancy loss was seen. No influence of FVL and/or ABO(H) on ante-natal bleeding or intra-partum or postpartum haemorrhage was observed. However, FVL was associated with birth-weights >90th centile [odds ratio (OR) 1.81; 95% confidence interval (CI(95)) 1.04-3.31] and neonatal death (OR 14.79; CI(95) 2.71-80.74). No association with ABO(H) alone, or any interaction between ABO(H) and FVL was observed. We neither confirmed the protective effect of FVL on pregnancy-related blood loss reported in previous smaller studies, nor did we find the increased risk of some vascular complications reported in retrospective studies.

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    • "Dienst et al., was the first to suggest that isoimmunization to the A or B antigen was a cause of pre-eclampsia [12]. This finding was supported by Pike and Dickins who reported a significant excess of group O in pre-eclamptic women [13] which was not found by Clark et al., [14]. Also, the ABO blood group has been associated with several thrombotic disease states; for instance, the blood group non-O increased the risk of venous thrombosis [15] [16] and ABO locus O 1 allele reduced the risk of myocardial infarction [17]. "
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    ABSTRACT: The purpose of the present study was to evaluate the association between pre-eclampsia and blood groups in a group of pregnant women hospitalized in a University Hospital in Porto Alegre, Brazil - Hospital São Lucas (HSL)/PUCRS. Our sample consisted of 10,040 pregnant women admitted to the maternity department of HSL between 2005 and 2010. The patients were reviewed retrospectively for inclusion. Medical records of 414 women were diagnosed as preeclampsia/eclampsia and 9611 women were identified to the control group. The patients were divided into two groups: the group with preeclampsia/eclampsia and the control group, and their blood groups were considered. Data were analyzed using SPSS for Windows version 17.0. Categorical data were summarized by counts and percentages, with the statistical significance evaluated by the Chi-square test. The null hypothesis was rejected when p<0.05. Maternal parameters were compared between control group and pre-eclampsia, respectively, Systolic Blood Pressure (117±19.98 vs. 165±19.99); Diastolic Blood Pressure (73±14.23 vs. 106±14.24) and maternal weight at booking (73±33 vs. 83±33). For all data: mean+SD; p<0.05. In relation to blood groups, firstly they were stratified by Rh and ABO phenotypes, separately. After that the groups were put together. No differences in blood group distribution were observed between controls and pre-eclampsia for any analysis. (p>0.05). When we adopted stricter criteria for pre-eclampsia and a large sample from the same region we noted that the results did not show any association between blood groups and the development of pre-eclampsia. Copyright © 2014 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.
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    • "). Likewise the prothrombin gene mutation is seen in 2.4% (Said et al. 2010a) to 6.2% (Salomon et al. 2004) of women. Three prospective cohort studies have examined only the association between factor V Leiden and adverse pregnancy events, and all failed to detect a statistically significant difference in the rate of pregnancy complications such as pre-eclampsia, fetal growth restriction, placental abruption or stillbirth amongst carriers of this mutation (Lindqvist et al. 1999; Dizon-Townson et al. 2005; Clark et al. 2008) (although one did show an association between neonatal death and factor V Leiden (Clark et al. 2008)). Dudding et al examined both factor V Leiden and prothrombin gene mutation and concluded that neither mutation was associated with the development of either pre-eclampsia or fetal growth restriction (Dudding et al. 2008). "

    Full-text · Chapter · Nov 2011
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    • "A clinical study found an improved hemoglobin status and reduced menstrual blood loss among female carriers of factor V Leiden (Lindqvist et al. 2001). Some investigators have also reported a possible lower risk of severe bleeding after delivery (Lindqvist et al. 1999; Rees et al. 1995; Zivelin et al. 1997), but this finding was not confirmed by a recent large prospective study (Clark et al. 2007). In addition, some benefit may have been obtained in reducing bleeding after trauma (especially during hunting and warfare), a common and life-threatening situation in prehistoric times (Caldwell and Caldwell 2003; Rees et al. 1995; Zivelin et al. 1997). "
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    ABSTRACT: Natural selection, drift, and gene flow are the three major evolutionary forces at the origin of genetic diversity among human populations. To further explore these mechanisms, we present an innovative approach using various medical genetic markers and focusing on the Basque population. From this study we can confirm the important role of drift in this endogamous human group and can report some disorders related to founder effects. Most important, the peculiar distribution of various polymorphisms, such as blood group O, factor V Leiden, DF508, C282Y, and CCR5 D32 mutations, which are implicated in resistance to infection, hemostasis, or iron conservation, could be interpreted as an adaptive profile. Multidisciplinary data have shown that the Neolithic period arrived significantly later in this southwestern corner of Europe. We hypothesize that the long-lasting Paleolithic mode of life, especially regarding nutrition and microbial exposure, was at the origin of this selective pressure within this population of ancient local ancestry. This approach could open new avenues in the field of population genetics.
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