Factor V Leiden and Hypercoagulation, A Cause of Multiple Miscarriages, Blood Clotting, and High Risk Pregnancy

Introduction:

Pregnancy can be affected by and can cause hypercoagulable states (times when the blood can clot more easily). In order to have a healthy pregnancy the body must keep a careful balance between clotting and bleeding. Hormones that help out pregnancy also increase the risk of clots.  The risk of blood clots increases 4-6 times during pregnancy.  1 out of 1,000 women may experience a clot due to pregnancy.  It is believed that clots account for 11% of all maternal deaths in the United States.1 This page will address some of the concerns that may arise during pregnancy.

How does clotting affect pregnancy?

Clotting can cause many problems during and soon after pregnancy.  Some of the risks of hypercoagulation are:

  • Pulmonary embolism
  • Deep vein thrombosis
  • Death
  • Unexplained fetal loss
  • Miscarriage
  • Preeclampsia
  • Placental abruption
  • Fetal growth restriction

Due to the increased risk of clotting, some doctors will recommend that women with clotting conditions or thrombophilia avoid pregnancy.  The good news is that typically a woman can carry a pregnancy to term safely as long as she is monitored and receives medical care appropriate for high risk pregnancies and clotting. 

Effects of thrombophilia on pregnancy

Anti Phospholipid Syndrome (APS)

Recurrent pregnancy loss

Often the way thrombophilia is discovered is when someone experiences recurrent pregnancy loss.  If a woman has lost 3 or more pregnancies the OBGYN will likely order blood tests to check for clotting disorders.  In particular, many doctors order a Factor V Leiden test.  The best test for FVL is a genetic test.  If FVL or another blood clotting disorder or condition is found, it is likely that the drug Lovenox or another low molecular weight heparin will be prescribed.

Thrombophilia and pregnancy

As clotting increases during pregnancy, individuals with thrombophilia need to be proactive in preventing clots. Even if a patient has not been on anticoagulation therapy before pregnancy, this therapy should be strongly considered throughout the pregnancy. Warfarin/Coumadin is not safe for a fetus. Medications other than warfarin must be used. One of the most common medications to be used is Lovenox. Lovenox is a low molecular weight heparin. LMWHs do not cross the placenta and are safe in pregnancy. Lovenox actually helps the pregnancy by preventing miscarriage and other pregnancy risks. Doctors will typically carry this treatment out 6 weeks past delivery. Depending on the clotting condition, doctors may also add aspirin and B-vitamins.

Pregnancy and clotting

A note on Coumadin/warfarin

It is important that Coumadin/warfarin is NOT used in pregnancy.  It is known to affect the pregnancy and will harm the baby.  A doctor can help to choose another medication for the pregnancy period such as Lovenox.  Coumadin appears to be safe with breast feeding.  Talk to your doctor to see what to use while pregnant, what to use immediately before delivery, and what to use when breastfeeding.  Remember that the postpartum period might be safe for your baby, but, you are still at risk.  Discuss continuing medication for a number of weeks past the delivery. 

It isn't catastrophic

Some doctors will panic when they discover a patient has Factor V Leiden or another thrombophilia. While on support groups, I have heard participants note that their doctors have told them that "under no circumstances should they become pregnant" or that "pregnancy is too risky and can not be safe". Remember that FVL and many other thrombophilias are genetic. Those of us with Factor V Leiden had a parent with Factor V Leiden. It is estimated that 5%, or, 1 out of every 20 Caucasians have FVL and that between 1 in 50 and 1 in 100 people of other ethnicities have FVL. That is only one of the types of thrombophilia. If all of the types of thrombophilia were accounted for, think how many people would have some type of clotting condition! Pregnancy is possible. You are not alone. There are people who can help you!

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Comments 7 comments

Lwelch profile image

Lwelch 4 years ago from USA Author

Yes, people can test negative. The DNA test always finds factor five but many docs measure the amounts of a certain clotting protein. Factor five affects that protein but the amounts of it free in blood varies and can lead to a negative result. Another situation can happen that no conditions are found because there is no currently known disease. Factor five was one of those until it was identified in the mid 1990's.


Natasha 4 years ago

I am currently pregnant...just found out. Have been on Coumadin since my stroke in July 2010 and found out I have FVL (both genes) when I had my stillborn daughter in February 2010. Thanks for the information because the only info I have found is ALL negative. So thanks again.


Lwelch profile image

Lwelch 4 years ago from USA Author

Natasha,

I am so glad that you found out before anything else bad happened to you, but I am so sorry about your daughter. I know that must give you a great sense of loss. I wonder if the stroke was from FVL. It is rare to see strokes due to it, but I believe they can be related.

Having 2 copies of the gene makes the risk of clots higher. You can read about that in some of my other pages. I only have one copy.

You will want to find a doctor who is not scarred of FVL. I am lucky, the OBGYN that I had pre-diagnosis was very comfortable with clots and has been helpful. I know when/if I get pregnant, he will walk me through the self injections, blood thinners, etc.

Try the support groups that I mentioned. They are said to be very good.

I think pregnancy will be more work for you but that with some careful planning, blood thinners during and after pregnancy, and understanding of the symptoms and risk you will find great hope.

After all, if you are here, you parents have FVL as well! In your case, with 2 copies of the gene, both parents have it, and they are both alive. Before the mid-nineties FVL didn't exist. Now we know more about it but it can cause fear. Before that we were having babies and miscarriages and nothing much was thought about it.


Kate61 4 years ago

Hi! I have FVL with two copies of the gene also. I was able to have three children. I didn't know about the FVL with my first pregnancy, until I got a blood clot in late pregnancy. With the other two kids I used Lovenex. It became second nature to take the injections. I know that you will be in good hands if you go to a high risk pregnancy doctor. They kept such a close eye on me. Good luck Natasha. And LWelch Thanks for this site and your others. I recently had a PE which was so scary. I will never try to go off Coumidan again! It was very helpful to see your page on recovery. I only stayed in the hospital for one night. I felt very abandoned when I got home-even with my helpful husband. I had no idea how long and hard and scary the recovery would be (still is). So thanks again for helping us to be more informed and less freaked out!


moonlake profile image

moonlake 4 years ago from America

My niece and my brother have Factor V Leiden. I was checked but didn't have it. My niece is suffering with blood clots in her arm now she had had them as far back as winter.

Good hub voted up.


Heather Says profile image

Heather Says 4 years ago from Buckeye, Arizona

Great info. I also had a PE in 2011. I was one week post op from a laparoscopy that found level three endometriosis. I had been on birth control therapy and bed rest prior to surgery. During my week-long hospitalization, the hematologist discovered I had factor II lieden and a lupus anti-coagulant mutation. I now take warfarin daily. I've been trying to get pregnant for five months, as the endometriosis is going untreated and they want to do a hysterectomy. I'd like at least one child, and it's proving to be a task. At that point, I'll be switched to heparin therapy as it will be the safest for the baby given my health factors. Thanks for sharing your story. Be well.


Lwelch profile image

Lwelch 4 years ago from USA Author

Wow! You got hit with a lot. I am glad that you had that diagnosed and that a PE was all that came of it. I am sure that pregnancy is stressful given everything. I know there are some treatments for fibroids but most do seem to either involve hormones or uterine surgery or removal. I know one of my friends had fibroids in high school and was worried about babies so she tried as soon as she was married. In the end she had in vitro and now has 3 kiddos. The stress of infertility drove her nuts. Best wishes with all of it!

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