Anti-Phosphatidylserine/Prothrombin Antibodies in Healthy Women with Unexplained Recurrent Pregnancy Loss

Abstract

Recurrent pregnancy loss (RPL) affects up to 6% of couples. Although chromosomal aberrations of the embryos are considered the leading cause, 50% of cases remain unexplained. Antiphospholipid Syndrome is a known cause in a few cases. Antiphospholipid antibodies (aPL) anticardiolipin, anti-Beta-2-Glycoprotein-I and Lupus Anticoagulant (criteria aPL) are recommended studies in RPL workup. We tested healthy women with unexplained RPL for criteria aPL and anti-Phosphatidylserine/Prothrombin antibodies (aPS/PT). Patients were classified into three groups according to the number and pregnancy week of RPL: Extra-Criteria (EC), with 2 miscarriages, Early Miscarriage (EM), with ≥3 before pregnancy at week 10 and Fetal Loss (FL), with ≥1 fetal death from pregnancy at week 10. Circulating criteria aPL were absent in 98.1% of EM, 90.9% of FL and 96.6% of EC groups. In contrast, aPS/PT were positive in 15.4% of EM, 15.1% of FL, 16.6% of EC patients and 2.9% in controls. aPS/PT posed a risk for RPL, with an odds ratio of 5.96 (95% confidence interval (CI): 1.85–19.13. p = 0.002) for EM, 7.28 (95% CI: 2.07–25.56. p = 0.002) for FL and 6.56. (95% CI: 1.77–24.29. p = 0.004) for EC. A successful live birth was achieved in all pregnant patients positive for aPS/PT who received treatment with heparin, aspirin and/or hydroxychloroquine.

Antiphospholipid Antibody Assays in 2021: Looking for a Predictive Value in Addition to a Diagnostic One

“…This is the case of the so-called tetrapositive patients (49). While aPS/PT have been reported in vascular APS, their association with the obstetric manifestations is still a matter of research (50)(51)(52). So, the inclusion of aPS/PT antibodies into the formal laboratory classification criteria has not been formally accepted up to now (32).…”

BushenHuoxue Recipe for the Treatment of Prethrombotic State of ACA-Positive Recurrent Miscarriage via the Regulation of the PI3K-AKT Signaling Pathway

“…Progesterone is primarily secreted by the ovarian corpus luteum and plays an important role in fertilized egg implantation and early pregnancy maintenance. It has various effects such as inhibiting maternal immune rejection, regulating membrane permeability of uterine smooth muscle cells, regulating invasion and migration ability of trophoblast cells, reducing the sensitivity of the uterus to contractile hormones, and inhibiting the contraction of uterine smooth muscle and anti-phospholipid to promote the implantation of fertilized eggs and normal development in the uterus [ 27 – 29 ].…”

Special Issue Recurrent Pregnancy Loss: Etiology, Diagnosis, and Therapy

“…Guidelines agree that RPL patients should be screened for the anti-phospholipid (aPL) antibodies (lupus anticoagulant, anti-cardiolipin antibodies and β2-glycoprotein-I antibodies), whereas screening for other aPL antibodies such as antiphosphatidyl (aPS)/prothrombin (PT) antibodies is not recommended. The study by Pleguezuelo et al [3] seems to indicate that aPS/PT antibodies may have a stronger association to RPL than the traditional aPL antibodies, with limited overlap between them. The results of the study call for more studies to clarify the importance of the non-traditional aPL antibodies.…”