Antibody to Cardiolipin as a Predictor of Fetal Distress or Death in Pregnant Patients with Systemic Lupus Erythematosus

Abstract

During a prospective study of pregnancies in women with systemic lupus erythematosus, we examined the relation between antibody to cardiolipin, measured by the enzyme-linked immunosorbent assay, and midpregnancy fetal distress, identified by abnormal results of antepartum fetal heart-rate testing or by fetal death. All of nine patients with lupus and this complication had abnormally high antibody levels (mean, 212.3 +/- 55.3 units), as compared with values in normal nonpregnant women (28.2 +/- 10.1 units). None of 12 pregnant patients with lupus but without this complication had antibody levels above 50 units (mean, 27.5 +/- 3.4 units; P less than 0.005 vs. women with lupus and fetal distress); 4 of 12 pregnant subjects without lupus had antibody levels above 50 units (mean, 42.5 +/- 11.0), and fetal death occurred in the subject with the highest level. The mean antibody level in 12 nonpregnant patients with lupus was 117.4 +/- 35.0 units. Two patients who had lupus anticoagulant but not clinical lupus, both with histories of prior fetal death, also had high antibody levels; fetal death occurred in one, and spontaneous fetal bradycardia in the other. Antibody to cardiolipin was loosely linked to a history, but not the simultaneous presence, of demonstrable lupus anticoagulant or thrombocytopenia, and could be detected as early in pregnancy as either anticoagulant or thrombocytopenia. We conclude that measurement of antibody to cardiolipin is the most sensitive assay to predict fetal distress or death in patients with systemic lupus erythematosus and may be of pathogenetic importance in this syndrome.

Origin and pathogenesis of antiphospholipid antibodies

“…Fetal death during the second or third trimester is more specific for aPL-associated fetal loss, but first-trimester spontaneous abortion is not uncommon. It was reported that 8% of women with first-trimester recurrent spontaneous abortions were aCL-positive (5,6). Placental insufficiency due to thrombosis is believed to cause fetal growth retardation, fetal demise, and preterm labor.…”

“…Antiphospholipid antibodies are strongly associated with clinical complications such as arterial and venous thrombosis (2,3), thrombocytopenia (1,4) and recurrent spontaneous abortions (5,6). The presence of aPL in patient sera in association with these complications has been denoted since 1986 as the antiphospholipid syndrome (APS) (7).…”

Anticorpos anticardiolipina e abortos espontâneos recorrentes em mulheres brasileiras

“…Several studies have reported a higher frequency of APA in cases of RSA, especially related to intrauterine fetal growth restriction and preeclampsia [7][8][9][10][11][12]. However, the importance of the APA in RSA remains controversial [13,14].…”

Hepatic venous outflow block in a young patient with Systemic Lupus Erythematosus

“…A system of venous collaterals may form around the occlusion that may be seen on imaging as a spider's web. 2,8 Hepatic venography is a reference procedure, but recently this invasive technique to measure venous pressure.…”

“…1, 3,7,8 The syndrome was described, at first, by Budd and Chiari in 1845 and 1899, respectively and has been mainly reported in East Asia, South Africa, and India. 13,14 The pathogenesis of vascular obstruction is still unclear but some cases of membranous obstruction of the IVC have been reported in Korea, and some cases have been known to have a relationship with oral contraceptive agents 15 or type B viral hepatitis.…”