Non-Criteria Obstetric Antiphospholipid Syndrome: How Different Is from Sidney Criteria? A Single-Center Study

Abstract

This study aims to compare the demographic characteristics, clinical features, serology, and fetal–maternal outcomes between women with obstetric antiphospholipid syndrome (APS) and those with non-criteria (NC)-APS and seronegative (SN)-APS. Two-hundred and sixty-three women with APS obstetric morbidity ever pregnant were included. Of those, 66 met the APS classification criteria, 140 were NC-APS, and 57 were SN-APS. Patients with other autoimmune diseases were excluded. Adverse pregnancy outcomes (APO) included early pregnancy loss, fetal death, preeclampsia, abruptio placentae, and preterm birth. The mean age of the study group was 33.6 ± 5.3 years, and patients were followed up for 129.5 ± 81.9 months. In the NC-APS group, 31 (22.1%) did not fulfill clinical and serological criteria (Subgroup A), 49 (35%) did meet clinical but not serologic criteria (Subgroup B), and 60 (42.9%) fulfilled the serologic criteria but not the clinical ones (Subgroup C). The cardiovascular risk burden was higher in the APS group, due to a higher proportion of smoking. Patients with criteria APS received more intensive treatment than patients in the other study groups. The addition of standard of care (SoC) treatment significantly improved live birth and decreased APO in all groups. Significant clinical differences were observed between the study groups. However, when treated with SoC, fetal–maternal outcomes were similar, with a significant improvement in live births and a decrease in APO. Risk stratification in patients with obstetric morbidity associated with APS can help individualize their treatment.

Impact of Inherited Thrombophilia in Women with Obstetric Antiphospholipid Syndrome: A Single-Center Study and Literature Review

“…Thus, in this study, we analyze the impact of IT on the obstetric outcome and thrombotic risk in a large cohort of patients belonging to the obstetric APS spectrum, including NC-APS and SN-APS. As previously reported [16], and notwithstanding the differences inherent to the definition of the study groups, the obstetric prognosis of patients on SoC therapy is very similar and overall satisfactory. However, despite appropriate treatment, a significant proportion of patients develop at least one APO.…”

“…The mean age of the overall group was 33.9 ± 5.3 years, and the median follow-up was 35 (11-79) months. Overall, as previously described [16], the prevalence of classic cardiovascular risk factors ranged from 45% to 62% and were especially prevalent in patients with APS. In addition, the most frequent comorbidities with a potential impact on the obstetric outcome, such as IT, thyroid disease, or obstetric comorbidities, were also frequent in all study groups.…”

“…On the other hand, as has been pointed out, pregnancy entails a procoagulant state per se. However, the frequency of thromboembolic events during pregnancy, even in patients with APS, is quite low [ 16 ]. The global frequency of antenatal DVT is 0.615/1000 pregnancies in women under 35 years and almost double (1.216/1000) in those older than that.…”

“…This retrospective cohort study included 397 consecutive women followed at the Autoimmune Diseases Pregnancy Clinic, a multidisciplinary unit of a teaching tertiary care hospital, between 2005 and 2022. Inclusion criteria were (a) patients included in previously well-defined clinical–serological subgroups [ 16 ], (b) IT study available, and (c) at least one clinical pregnancy ( Figure 1 ).…”

Estudio comparativo de las complicaciones vasculares placentarias en pacientes con síndrome antifosfolípido obstétrico criterio y no criterio

“…El estudio EUROAPS incluye complicaciones no criterio como 1 o 2 abortos tempranos, y además manifestaciones no criterio a nivel de laboratorio. Dos publicaciones recientes de 2022, una revisión sistemática (5) y un estudio de cohorte retrospectivo (6) , confirmaron el beneficio en la prevención de complicaciones obstétricas al realizar tratamiento a las pacientes con NC-SAFO. No hay estudios que evalúen únicamente los pacientes con complicaciones vasculares placentarias como el nuestro, pero en 2018 Branch y colaboradores (7) publicaron un estudio caso control PREPI (Preterm delivery for preeclampsia or placental insufficiency) e incluyeron pacientes embarazadas hasta la semana 36 (criterio más amplio que las 34 semanas Tabla 3.…”