Factor v Leiden and antiphospholipid antibodies in either mothers or infants increase the risk for perinatal arterial ischemic stroke

Stroke. 2009 Jan;40(1):65-70. doi: 10.1161/STROKEAHA.108.527283. Epub 2008 Oct 16.

Abstract

Background and purpose: The objective was to investigate the role of infant and maternal thrombophilia in a cohort of mothers and infants presenting with perinatal arterial ischemic stroke.

Methods: Forty-seven infants with clinically and radiologically confirmed perinatal arterial ischemic stroke underwent thrombophilia workup: factor V Leiden (FVL), PII20210A mutation, Methylene-tetrahydrofolate reductase 677T polymorphism, protein C, protein S, antithrombin, FVIII, and antiphospholipid antibodies. Thrombophilia data were available for 23 mother-infant pairs and compared with control populations to evaluate the risk for PAS.

Results: Thirty of 47 (64%) infants and 15 of 22 mothers (68%) had evidence of thrombophilia. In 18 of 23 (78%) mother-infant pairs, there was at least 1 thrombophilic risk factor, but 15 pairs were mismatched in pathology. Among infants, FVL, protein C deficiency, and presence of antiphospholipid antibodies prevailed (OR, 4.2; 95% CI, 1.5-11.3; OR, 12.2; 95% CI, 2.5-59.9; OR, 4.1; 95% CI, 1.4-12.2, respectively). Interestingly FVL prevailed in almost one-third of mothers (OR, 8.5; 95% CI, 4.1-17.5) and 18% of mothers had antiphospholipid antibodies (OR, 3.8l; 95% CI, 1.5-10.0).

Conclusions: Maternal and neonatal thrombophilia, especially presence of FVL or antiphospholipid antibodies, may be important in the pathogenesis of perinatal arterial ischemic stroke. The nature of thrombophilic mother-infant risk potential interactions warrants further investigation.

MeSH terms

  • Adolescent
  • Autoantibodies / analysis
  • Autoantibodies / blood*
  • Biomarkers / analysis
  • Brain Ischemia / genetics*
  • Brain Ischemia / immunology
  • Brain Ischemia / pathology
  • Cerebral Arteries / pathology
  • Cerebral Arteries / physiopathology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Factor V / genetics*
  • Female
  • Genetic Markers / genetics
  • Genetic Predisposition to Disease / genetics
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Maternal-Fetal Exchange / genetics
  • Maternal-Fetal Exchange / immunology
  • Mutation / genetics
  • Phospholipids / immunology*
  • Pregnancy
  • Prospective Studies
  • Risk Factors
  • Stroke / genetics*
  • Stroke / immunology
  • Stroke / pathology
  • Thrombophilia / genetics*
  • Thrombophilia / immunology
  • Thrombophilia / pathology

Substances

  • Autoantibodies
  • Biomarkers
  • Genetic Markers
  • Phospholipids
  • factor V Leiden
  • Factor V