How does factor XIII (FXIII) deficiency affect pregnancy outcomes?

Updated: Aug 01, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Perumal Thiagarajan, MD  more...
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In the latter half of pregnancy, some drop in FXIII levels is normal, but severe (homozygous) FXIII deficiency is a cause of recurrent miscarriages. In a study of gestational tissues, FXIII was found in the decidual layer of the placenta, while FXIII secretion was evident in cultures of round-shaped endometrial cells. A study of early (7-8 wk) gestational tissues obtained from women without FXIII deficiency and from a woman who was homozygous for FXIII deficiency showed poorly formed cytotrophoblastic shells and Nitabuch layers, along with absence of FXIIIa in tissues obtained from the woman with FXIII deficiency. Low plasma levels of FXIII appear to correlate with low placental levels of FXIII with poor trophoblastic development, which may be the cause of spontaneous miscarriages.

It has been suggested that preventing miscarriage in patients who are severely deficient requires FXIII supplementation beginning at approximately 5 weeks of gestation because FXIII, fibrinogen, and fibronectin are necessary to anchor cytotrophoblasts invading the endometrium. [43, 44] Reduced FXIII activity resulting from the Tyr204Phe mutation has been associated with repeated miscarriages. [45]

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