Association of inherited thrombophilia mutations and their combinations among palestinian women with unexplained recurrent miscarriage

Ayman A Najjar; Imam Hassouna; Mahmoud A Srour; Hany M Ibrahim; Randa Y Assi; Heba M Abd El Latif

doi:10.1186/s12959-024-00587-7

Association of inherited thrombophilia mutations and their combinations among palestinian women with unexplained recurrent miscarriage

Thromb J. 2024 Feb 13;22(1):20. doi: 10.1186/s12959-024-00587-7.

Authors

Ayman A Najjar¹, Imam Hassouna¹, Mahmoud A Srour^{2

3}, Hany M Ibrahim⁴, Randa Y Assi⁵, Heba M Abd El Latif¹

Affiliations

¹ Physiology Unit, Zoology Department, Faculty of Science, Menoufia University, Shibin El Kom, Egypt.
² Department of Biology and Biochemistry, Faculty of Science, Birzeit University, Birzeit, Palestine. msrour@birzeit.edu.
³ Clinical Laboratory Science Program, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine. msrour@birzeit.edu.
⁴ Physiology Unit, Zoology Department, Faculty of Science, Menoufia University, Shibin El Kom, Egypt. hany.mohamed@science.menofia.edu.eg.
⁵ Department of Obstetrics & Gynecology, Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.

Abstract

Background: Inherited thrombophilia (IT) has a complex pathophysiology and is associated with recurrent miscarriage (RM) by causing placental insufficiency and inhibiting fetal development. However, thrombophilia screening in unexplained RM cases is still questionable. This study aimed to investigate the association between the common eight IT mutations and their combinations among Palestinian women with unexplained RM.

Methods: This is an unmatched case-control study with 200 women (100 unexplained RM cases, 100 controls). Eight common IT mutations namely Factor V Leiden (FVL), prothrombin gene (FII) G202120A, Methylenetetrahydrofolate Reductase (MTHFR) gene (C677T and A1298C), B-fibrinogen gene - 455G > A, FV HR2 A4070G, Plasminogen activator inhibitor 1 (PAI1) 5G/4G and Factor XIIIA (FXIIIA) V34L; were analyzed. The first five mutations were analyzed by Restriction Fragment Length Polymorphism PCR and the other three mutations were analyzed using Amplification Refractory Mutation System PCR.

Results: The prevalence of the eight IT mutations among the control group was in the order PAI1 5G/4G (69%), MTHFR C677T (53%) and A1298C (47%), BFG - 455G > A (35%), FVL and FV HR2 (each 18%), FXIIIA V34L (16%) and FII G20210A (3%). Patients had a higher percentage of MTHFR A1298C (heterozygotes and mutant homozygote) compared to controls (p = 0.016). Frequencies of mutant alleles MTHFR A1298C (p < 0.001) and FXIIIA V34L (p = 0.009) were higher among patients compared to controls. No significant differences were observed for all other mutations or mutant alleles. Most patients (75%) and controls (75%) have 2-4 mutant alleles out of 8 mutant alleles studied, while 1% of patients and 2% of controls have zero mutant alleles. None of the combinations of the most often studied mutations (FVL, FII G20210A, MTHFR C1677T, and MTHFR A1298C) showed a significant difference between patients and controls.

Conclusions: There was a significant association between unexplained RM and the mutant alleles of MTHFR A1298C and FXIIIA V34L. No significant association was observed between unexplained RM and the combination of both mutant alleles for the mutations studied. This study is the first Palestinian report that evaluates eight inherited thrombophilia mutations and their alleles' combinations in unexplained RM cases.

Keywords: Inherited thrombophilia mutations; Palestine; Prevalence; Recurrent miscarriage; Women.

Grants and funding

XXXX/Horus Company for Medical and Educational Services, Ramallah, Palestine