Antiphospholipid syndrome: An update on risk factors for pregnancy outcome

Carolis, Sara De; Tabacco, Sara; Rizzo, Francesca; Giannini, Andrea; Botta, Angela; Salvi, Silvia; Garufi, Cristina; Panici, Pierluigi Benedetti; Lanzone, Antonio

doi:10.1016/j.autrev.2018.03.018

Cited by 64 publications

(49 citation statements)

References 68 publications

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“…aPL induced a direct pathogenic role such as a procoagulant and proinflammatory response in vascular and obstetric events, 1 especially triple aPL positivity, confirmed as the most significant risk factor by a large body of evidence. 9 Among them, either LA or anti-b2GP1, or both have been suggested as the highest risk factor associated with adverse events through different studies. [10][11][12] The prognosis of pregnancies had improved greatly for APS, but 20-30% of APS women were still struggled in the way of having a healthy neonate even with conventional treatment of prophylactic heparin plus low-dose aspirin (LDA) in Europe.…”

Section: Introductionmentioning

confidence: 99%

Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

Cai

et al. 2020

Clin Appl Thromb Hemost

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The purpose of our study was to evaluate pregnancy outcomes of women with antiphospholipid antibodies (aPL) positivity and assess risk factors associated with adverse pregnancy outcomes. Pregnant women with aPL positivity were enrolled prospectively in China from January 2017 to March 2020. Treatment of low-dose aspirin and low molecular weight heparin were given. Pregnancy outcomes and coagulation function were recorded and compared with normal pregnancies. Multivariable logistic regression was performed to identify risk factors associated to intrauterine growth restriction (IUGR). 270 pregnant women, including 44 diagnosed as Antiphospholipid syndrome (APS), 91 as non-criteria APS (NCAPS) and 135 normal cases as control, were enrolled in the study. The live birth rate in aPL carriers and APS group was 97% and 95.5%, respectively. Adverse pregnancy outcomes did not show significant difference between aPL carriers and normal pregnancies, and between APS and NCAPS, except for IUGR. The incidence of IUGR was significantly higher in aPL carriers than normal pregnancies, and in APS patients than NCAPS (P < 0.05). After controlling for age, in vitro fertilization (IVF), pregnancy losses related to APS and treatment, anticardiolipin (aCL) positivity was the only variable significantly associated with IUGR, with an adjusted odds ratio of 4.601 (95% CI, 1.205-17.573). Better pregnant outcomes of aPL positive women, include APS and NCAPS, were achieved in our study with treatment based on low-dose aspirin (LDA) plus low molecular weight heparin (LMWH). The incidence of IUGR was still higher in them, and aCL positivity was the only one risk factor associated with IUGR.

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Section: Introductionmentioning

confidence: 99%

Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

Cai

et al. 2020

Clin Appl Thromb Hemost

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“…[1] This disease affects a minority of women, and is associated with maternal and fetal complications such as miscarriage, eclampsia, fetal intrauterine growth retardation, preterm delivery, and neonatal mortality. [2]…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in patients with primary antiphospholipid syndrome

Liu

Sun

2019

Medicine

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Background: Antiphospholipid syndrome (APS) is a rare heterogenous autoimmune disorder with severe life-threatening complications shown during pregnancy. In this analysis, we aimed to systematically compare the pregnancy outcomes (both maternal and fetal) in patients with APS. Methods: Web of Science, Google Scholar, Medicus, Cochrane Central, Embase, and Medline were searched for relevant English publications. The main inclusion criteria were based on studies that compared pregnancy outcomes in patients with APS vs a control group. Statistical analysis was carried out by the RevMan software version 5.3. This analysis involved dichotomous data, and risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the analysis. Results: Eight studies consisting of a total number of 212,954 participants were included. Seven hundred seventy participants were pregnant women with APS and 212,184 participants were assigned to the control group. Pregnancy-induced hypertension was significantly higher in women with APS (RR: 1.81, 95% CI: 1.33 – 2.45; P = .0002). The risks of fetal loss (RR: 1.33, 95% CI: 1.00–1.76; P = .05), abortion (RR: 2.42, 95% CI: 1.46–4.01; P = .0006), thrombosis (RR: 2.83, 95% CI: 1.47–5.44; P = .002), and preterm delivery (RR: 1.89, 95% CI: 1.52–2.35; P = .00001) were also significantly higher in women with APS. However, placental abruption (RR: 1.35, 95% CI: 0.78–2.34; P = .29) and pulmonary embolism were not significantly different (RR: 1.47, 95% CI: 0.11–19.20; P = .77). The risk of neonatal mortality (RR: 3.95, 95% CI: 1.98–7.86; P = .0001), infants small for gestational age (RR: 1.38, 95% CI: 1.04–1.82; P = .02), premature infants (RR: 1.86, 95% CI: 1.52–2.28; P = .0001), and infants who were admitted to neonatal intensive care unit (RR: 3.35, 95% CI: 2.29–4.89; P = .00001) were also significantly higher in women with APS. Conclusion: This analysis showed APS to be associated with significantly worse pregnancy outcomes when compared to the control group. A significantly higher risk of maternal and fetal complications was observed in this category of patients. Therefore, intense care should be given to pregnant women with APS to monitor unwanted outcomes and allow a successful pregnancy.

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“…(Antovic et al 2018;Cochery-Nouvellon et al 2017). OAPS has been referred to as a severe acquired risk factor for recurrent abortions, fetal losses, pre-eclampsia, placental insufficiency and represents an important health threat for women of childbearing age (Antovic et al 2018;Carolis et al 2018;Marchetti et al 2013). Natural killer (NK) cells have been implicated to play a critical role in the processes of reproduction (Abel et al 2018;Van den Hoogen et al 2016), which are associated with implantation failures, recurrent miscarriage and infertility due to either cytotoxicity or receptor expressions (Lee et al 2019;Ryan et al 2001;Tabiasco et al 2006).…”

Section: Introductionmentioning

confidence: 99%

Increased Peripheral NKG2A-NKG2D+CD3-CD16+CD56dim NK Cell Subset Was Positively Correlated with Antiphospholipid Antibodies in Patients of Obstetric Antiphospholipid Syndrome

Zhang

Zhao

et al. 2020

Immunological Investigations

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Obstetric antiphospholipid syndrome (OAPS) is an autoimmune disorder with severe life-threatening complications shown during pregnancy. It has been reported that the increase in CD16 + CD56 dim natural killer (NK) cells in peripheral blood are risk factors for recurrent miscarriages, but this expression of CD16 + CD56 dim NK cells in OAPS patients has not been reported, and the mechanism is not clearly illustrated. In this study, we compared the distributional profiles of different NK cell subsets and the expressions of NK cell-activating receptors in peripheral blood of patients with OAPS and healthy women. Our results showed significantly increased NKG2A − NKG2D + subset and decreased NKG2A + NKG2D − subset in CD3 − CD16 + CD56 dim NK cells, CD3 − CD16 − CD56 bright NK cells and CD56 + T cells in OAPS patients compared with those in healthy control women. The CD27 − CD11b + subset significantly increased in CD3 − CD16 + CD56 dim NK cells in OAPS patients compared with those in healthy control women. In addition, the NKG2A − NKG2D + subset in CD3 − CD16 + CD56 dim NK subset in triple positivity was higher than single positivity OAPS patients. At the optimal diagnostic threshold established by ROC analysis, using the cutoff of NKG2A − NKG2D + and CD27 − CD11b + subset in CD3 − CD16 + CD56 dim NK cells is 10.10% and 92.75%, the sensitivity of NKG2A − NKG2D + and CD27 − CD11b + to detect patients with OAPS compared with healthy control results was 94.1% and 60.8%, and specificity was 84.2% and 89.5%, respectively, with an area under the curve (AUC) of 0.903 and 0.829, respectively. The NKG2A − NKG2D + subset in CD3 − CD16 + CD56 dim NK cells was positively correlated with the antiphospholipid antibodies lg anti-aCL IgG, lg anti-aCL IgM, lg anti-aCL IgA, lg anti-β2GP1 IgM and Complement 4 (C4), while the CD27 + CD11b + subset in CD3 − CD16 + CD56 dim NK cells was correlated with lg anti-β2GP1 IgG and lg anti-β2GP1 IgA. These results suggested that the NK cytotoxic function enhanced in OAPS patients and unbalanced of NK activating receptors and inhibiting receptors may contribute to the immune pathogenesis of OAPS.

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Antiphospholipid syndrome: An update on risk factors for pregnancy outcome

Cited by 64 publications

References 68 publications

Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

Pregnancy outcomes in patients with primary antiphospholipid syndrome

Increased Peripheral NKG2A-NKG2D+CD3-CD16+CD56dim NK Cell Subset Was Positively Correlated with Antiphospholipid Antibodies in Patients of Obstetric Antiphospholipid Syndrome

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