Laboratory and clinical features of pregnant women with antiphospholipid syndrome and neonatal outcome

Abstract

Objective. To evaluate the relationship between the antiphospholipid profile and clinical characteristics of pregnant women with antiphospholipid syndrome (APS) and neonatal outcome. Methods. We retrospectively considered 109 treated pregnancies of 93 patients with primary APS and reviewed the medical records of their 111 infants. Neonatal outcome was assessed using the following variables: weeks of gestational age at delivery, percentiles of birth weight, Apgar score at 5 minutes, need for cardiopulmonary resuscitation in the delivery room, time in the neonatal intensive care unit, infections, and other neonatal complications. Univariate statistical analysis was performed to evaluate the relationship between APS maternal features and neonatal outcome parameters. Results. When maternal APS features and variables of infant outcome were analyzed, it was evident that lupus anticoagulant (LAC), triple antiphospholipid positivity, and history of vascular thrombosis were significantly associated with some parameters of a poor infant outcome. History of pregnancy morbidity alone was, instead, significantly correlated to the variables of favorable neonatal outcome. Conclusion. There seems to be more than one kind of pregnant woman with APS. Even when treated with a second-line therapy plan, mothers with LAC and/or triple antiphospholipid positivity and/or previous thromboembolism seem to have a high probability of poor neonatal outcome, whereas those with pregnancy morbidity alone, treated with conventional drugs, seem to have a high probability of favorable outcome.

Comparative incidence of pregnancy outcomes in treated obstetric antiphospholipid syndrome: the NOH-APS observational study

“…8 Other recent retrospective work on pregnant APS patients, including also thrombotic APS, did not focus on placentamediated complications. 17,18 A study considering high antibody titers found an association with some adverse pregnancy outcomes, but included thrombotic and obstetric patients, without analyzing the effect of subcategorization of pregnancy losses. 24 The presence of aCL-M was a risk factor for placenta-mediated complications and LA for SGA neonates.…”

“…10,25 Prior studies report an association between LA positivity and pregnancy loss despite antithrombotic treatments. 17,18 These studies included APS patients with a history of thrombosis, a history of both thrombosis and pregnancy morbidity being a risk factor for pregnancy failure. 18 Past thrombosis may thus act as a confounding factor on the risk of pregnancy loss in LA-positive patients.…”

“…None had only ab2GP1-Ab. Nearly one-third of the patients exhibited triple positivity, [17][18][19] which was due in part to the high frequency of aCL-M-positive patients. In the APS group, 3.3% of women were positive for the F5 rs6025 or F2 rs1799963 polymorphisms.…”

Antiphospholipid syndrome: laboratory detection, mechanisms of action and treatment

“…In triple-positive patients with impending pregnancy loss or in patients with previous thromboembolism or those in whom the standard (LMWH plus low-dose aspirin) protocol fails (about 30% of cases) [89,93,94], rescue therapy should be employed. This includes either the use of i.v.…”

ROLE OF ANTICARDIOLIPIN (aCL) ANTIBODIES IN BAD OBSTETRIC HISTORY (BOH) DETECTED BY ELISA TEST IN A TERTIARY CARE CENTRE

“…The risk of developing complications due to antiphospholipid antibodies in pregnancy is difficult to assert. But a previous bad obstetric history, history of thrombosis and triple positivity for lupus anticoagulant, anticardiolipin and anti-β2 glycoprotein antibodies are the high risk factors (13,14). The anticardiolipin antibody assay by ELISA technique is a simple and highly sensitive method which helps in the diagnosis of APS.…”