Lipoprotein (A) and Further Prothrombotic Risk Factors in Women with Unexplained Recurrent Miscarriage- Results of a Multicenter Case-Control Study.

Background The present study was performed to assess the association of prothrombotic risk factors and underlying conditions, e.g. smoking and obesity, with unexplained recurrent miscarriage (uRM) in white women.

Methods and Results From 1998 to 2003, 133 Caucasian women aged 18–42 years (median 28 years) suffering from uRM were consecutively enrolled. In patients and 133 age-matched healthy controls prothrombotic risk factors (factor V (FV) G1691A, factor II (FII) G20210A, MTHFR T677T, 4G/5G plasminogen activator inhibitor (PAI)-1, lipoprotein (Lp) (a), protein C (PC), protein S (PS), antithrombin (AT), antiphospholipid/anticardiolipin (APA/ACA) antibodies) as well as associated environmental conditions were investigated. 70 (52.6%) of the patients had at least one prothrombotic risk factor compared with 26 control women (19.5%; p<0.0001). Body mass index (BMI; p=0.78) and smoking habits (p=0.44) did not differ significantly between the groups investigated. Upon univariate analysis the heterozygous FV mutation, Lp(a) > 30 mg/dL, increased APA/ACA and BMI > 25 kg/m² in combination with a prothrombotic risk factor were found to be significantly associated with uRM. Associations of the heterozygous FII variant, MTHFR or 4G/4G PAI-1 genotypes, deficiency states of PC, PS and AT, as well as the combination of smoking with at least one prothrombotic risk factor did not reach statistical significance. In multivariate analysis, increased Lp(a) (odds ratio (OR): 4.7/95% confidence interval (CI): 2.0–10.7), the FV mutation (OR:3.8/CI:1.4–10.7), and increased APA/ACA (OR: 4.5/CI: 1.1–17,7) had independent associations with uRM.

Conclusion In Caucasian women uRM is associated with the presence of elevated Lp(a) or further prothrombotic risk factors.