Obstetrical outcome and treatments in seronegative primary APS: data from European retrospective study

Abstract

ObjectiveTo compare characteristics, pregnancies and treatments during pregnancies of seronegative and seropositive antiphospholipid syndrome (APS), to analyse factors associated with obstetrical outcome.Patients and methodsInclusion criteria were: (1) thrombotic and/or obstetrical APS (Sydney criteria); (2) absence of conventional antiphospholipid antibodies (APL); (3) at least one persistent non-conventional APL among IgA anticardiolipin antibodies, IgA anti-B2GPI, anti-vimentin G/M, anti-annexin V G/M, anti-phosphatidylethanolamine G/M and anti-phosphatidylserine/prothrombin G/M antibodies. The exclusion criteria were: (1) systemic lupus erythematosus ( SLE) or SLE-like disease; and (2) other connective tissue disease.ResultsA total of 187 women (mean 33±5 years) with seronegative APS were included from 14 centres in Austria, Spain, Italy, Slovenia and France and compared with 285 patients with seropositive APS. Seronegative APS has more obstetrical rather than thrombotic phenotypes, with only 6% of venous thrombosis in comparison to seropositive APS. Cumulative incidence of adverse obstetrical events was similar in seronegative and seropositive APS patients, although higher rates of intrauterine deaths (15% vs 5%; p=0.03), of preeclampsia (7% vs 16%, p=0.048) and lower live birth term (36±3 vs 38±3 weeks of gestation; p=0.04) were noted in seropositive APS. The cumulative incidence of adverse obstetrical events was significantly improved in treated versus untreated seronegative APS (log rank<0.05), whereas there was no difference between patients who received aspirin or aspirin-low-molecular weighted heparin combination.ConclusionSeveral non-criteria APL can be detected in patients with clinical APS features without any conventional APL, with various rates. The detection of non-criteria APL and thus the diagnosis of seronegative APS could discuss the therapeutic management similar to seropositive APS, but well-designed controlled studies are necessary.

Pathogenesis, Diagnosis and Management of Obstetric Antiphospholipid Syndrome: A Comprehensive Review

“…Similar results were reported by Gardiner et al [120]. At least two different studies from the EUROAPS study group, referring to the outcomes between groups and criteria and non-criteria laboratory OAPS, showed the same obstetric events in cases treated or non-treated with SC [120,121]. (iii) Laboratory pitfalls or technical limitations in ELISA tests [13,122].…”

Management of Antiphospholipid Syndrome

“…In a retrospective study that compared 65 women with seronegative APS with 83 seropositive APS and 31 healthy pregnant women, treatment with LDA and LMWH was significantly associated with live births in both seropositive and seronegative women compared with controls [ 69 ]. This finding was corroborated by a recent multicentre case series [ 70 ].…”

A case of hypertensive disorders of pregnancy that developed at 9 weeks of gestation

“…Seronegative APS (SN-APS) has also been suggested as a differential diagnosis. SN-APS is defined in patients with clinical APS features according to Sydney criteria, but without detectable conventional aPL and obstetric events are more frequent than thrombosis in SN-APS patients [11]. Our case did not meet the laboratory and clinical criteria for SN-APS.…”