Antiphospholipid antibodies and the risk of severe and non‐severe pre‐eclampsia: the NOHA case‐control study

Abstract

To cite this article: Marchetti T, de Moerloose P, Gris JC. Antiphospholipid antibodies and the risk of severe and non-severe pre-eclampsia:the NOHA case-control study. J Thromb Haemost 2016; 14: 675-84. EssentialsWe studied the incidence of antiphospholipid antibodies (aPLs) in women with previous pre-eclampsia. Plasma was tested for classical aPLs and other 'new' antibodies such as antib2GP1 domain I IgG. Severe pre-eclampsia is distinct from non-severe and is mainly associated with antib2GP1 IgG. Specific antib2GP1 antibodies IgG against domain I correlate with other aPL IgG tests.Summary. Background: pre-eclampsia (PEecl) can be defined as non-severe (NS-PEecl) or severe (S-PEecl). Our study aimed to determine the incidence of antiphospholipid antibodies (aPLs) in women with a past history of NSPEecl or S-PEecl. Patients and Methods: This case-control study includes 195 control women, 199 NS-PEecl patients and 143 S-PEecl patients whose plasma samples were collected 6 months after their first delivery. Each plasma was tested for lupus anticoagulant (LA), anticardiolipin (aCL) and antib2GP1 antibodies, as well as antibodies against phosphatidylserine/prothrombin complex (aPS/PT) and domain I of the b2GP1. Results: When compared with the control group no significant associations were found for the NS-PEecl group after adjustment of confounding variables. For the S-PEecl group, there was an association with antib2GP1 immunoglobulin G (IgG) (OR 16.91, 95% CI 3.71-77.06), as well as age, obesity, smoking and multiparity. Antib2GP1-domain I IgG was associated with aCL, antib2GP1 and aPS/PT IgG in the three groups. aPS/PT IgG was associated with aCL IgG, and aPS/PT IgM was associated with aCL and antib2GP1 IgM in the three groups. Conclusion: S-PEecl is a distinct entity from NSPEecl and is mainly associated with the presence of antib2GP1 IgG. Antib2GP1 domain I correlates with other aPL IgG tests, and aPS/PT may be promising in patients for whom LA tests cannot be interpreted.

First‐Line, Non‐Criterial Antiphospholipid Antibody Testing for the Diagnosis of Antiphospholipid Syndrome in Clinical Practice: A Combination of Anti–β2‐Glycoprotein I Domain I and Anti–Phosphatidylserine/Prothrombin Complex Antibodies Tests

“…Anti‐PS/PT antibodies are another major type of aPL responsible for LAC activity, in addition to anti‐β 2 GPI antibodies . They are frequently detected in patients with APS and are strongly correlated with the occurrence of thrombosis and obstetric complications .…”

Are Anti-β2 Glycoprotein 1 Antibodies Associated with Placenta-Mediated Pregnancy Complications? A Nested Case–Control Study

“…In a nested case-control study evaluating 342 cases with preeclampsia compared with 195 controls without preeclampsia, anti-β2GP1 (> 99th percentile) was associated with preeclampsia in severe cases but not in mild (nonsevere) cases. 2 Similarly, only an association between anti-β2GP1 and severe preeclampsia was found in a Spanish case-control study of 182 patients. 22 In contrast, another case-control study found no association with anti-β2GP1 antibodies in women with any form of preeclampsia, including those with HELLP (Hemolysis, Elevated Liver enzyme levels, and Low Platelet levels), severe or early-onset (< 34 weeks' gestation) preeclampsia, when compared with women without preeclampsia.…”

“…Unfortunately, the link between anti-β2GP1 antibody positivity and obstetrical complications is tenuous. [1][2][3][4] If we can confirm an association between anti-β2GP1 antibody positivity and placentamediated pregnancy complications, then we can strengthen screening recommendations and advance research aimed at modifying this risk. 5 Placenta-mediated pregnancy complications include preeclampsia, placental abruption, late pregnancy loss, and birth of a small-for-gestational age (SGA) infant; the etiology is often multifactorial and may include abnormal coagulation activation at the maternal-fetal interface.…”

“…3 Marchetti et al found an association between anti-β2GP1 IgG antibody positivity and severe preeclampsia in a nested case-control study that evaluated 342 women with preeclampsia. 2 Silver et al reported an association between anti-β2GP1 IgG antibody positivity and stillbirths in a case-control study of 582 stillbirth deliveries (OR, 3.17, 95% CI, 1.30-7.72). 17 Why is this problem important to solve?…”

The clinical value of measuring antiphospholipid antibodies in high risk primigravidae and nullipara, a case control study

“…15 Marchetti et al reported no association between Anti β2 GPI IgG and non-severe pre-eclampsia, but reported a significant association in cases of severe pre-eclampsia. 16 Rezk et al stated that there was no significant relation between Anti β2 GPI and development of pre-eclampsia, but its presence is an independent risk factor of pregnancy loss. 17 Anti-cardiolipin antibodies were negative in 100% of cases of both high risk and control groups with no significant difference in mean levels between both study groups nor between the three subgroups and the control groups except for the mean level of Anti-cardiolipin IgG antibodies among high risk group which was significantly lower than that of the control group suggesting higher but still normal level in the control group.…”