Pregnancy outcome predictors in antiphospholipid syndrome: A systematic review and meta-analysis

Walter, Isabel; Haneveld, Mirthe J Klein; Lely, A. Titia; Bloemenkamp, K.W.M.; Limper, Maarten; Kooiman, Judith

doi:10.1016/j.autrev.2021.102901

Cited by 48 publications

(31 citation statements)

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“…The women without APS laboratory and clinical risk factors, who experienced pregnancy failure while being treated with heparin/LDA, were defined as “refractory obstetric APS,” whereas APS patients with one or more laboratory and/or clinical risk factors who may or may not have experienced adverse pregnancy outcomes despite treatment with heparin/LDA were defined as “high-risk and/or refractory obstetric APS”. In accordance with the literature ( Sailer et al, 2006 ; Ruffatti et al, 2011 ; Lockshin et al, 2012 ; Matsuki et al, 2015 ; Latino et al, 2017 ; Saccone et al, 2017 ; Walter et al, 2021 ) laboratory risk factors were considered: persistent LA positivity alone or any combination of LA with IgG/IgM aCL antibodies or IgG/IgM anti-β2 glycoprotein I antibodies and triple aPL positivity (LA + IgG/IgM aCL antibodies + IgG/IgM anti-β2GPI antibodies). As highlighted in the literature ( Ruffatti et al, 2011 ; Walter et al, 2021 ), thrombosis, systemic lupus erythematosus, and previous severe pregnancy complications were considered clinical risk factors.…”

Section: Methodsmentioning

confidence: 99%

“…In accordance with the literature ( Sailer et al, 2006 ; Ruffatti et al, 2011 ; Lockshin et al, 2012 ; Matsuki et al, 2015 ; Latino et al, 2017 ; Saccone et al, 2017 ; Walter et al, 2021 ) laboratory risk factors were considered: persistent LA positivity alone or any combination of LA with IgG/IgM aCL antibodies or IgG/IgM anti-β2 glycoprotein I antibodies and triple aPL positivity (LA + IgG/IgM aCL antibodies + IgG/IgM anti-β2GPI antibodies). As highlighted in the literature ( Ruffatti et al, 2011 ; Walter et al, 2021 ), thrombosis, systemic lupus erythematosus, and previous severe pregnancy complications were considered clinical risk factors. Severe pregnancy complications referred to one or more of the following: eclampsia, preeclampsia (new-onset hypertension ≥140/90 mm Hg and proteinuria ≥300 mg per 24-h urine collection protein), placental insufficiency (abnormal Doppler flow velocimetry waveform analysis of uterine arteries), hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome, and intrauterine growth retardation (IUGR) defined as postnatal birth weight less than 10th percentile for gestational age.…”

Section: Methodsmentioning

confidence: 99%

“…Following this treatment up to 70–80% of viable live infants could be achieved ( Bramham et al, 2010 ; Bouvier et al, 2014 ). In the 20–30% of failed pregnancies, a series of risk factors associated with unfavorable pregnancy outcomes have been described ( Sailer et al, 2006 ; Ruffatti et al, 2011 ; Lockshin et al, 2012 ; Matsuki et al, 2015 ; Latino et al, 2017 ; Saccone et al, 2017 ; Walter et al, 2021 ). Recently, both inflammatory and non-inflammatory pathogenetic mechanisms are described in APS placenta studies ( Tong et al, 2015 ; Vial and Chamley 2015 ), reflecting the different characteristics of obstetric features.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Refractory/High-Risk Pregnancies With Antiphospholipid Syndrome: A Systematic Review of the Literature

Hoxha

Tormene²,

Campello³

et al. 2022

Front. Pharmacol.

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Different treatment protocols have been employed to manage heparin/low-dose aspirin refractory or high-risk pregnancies in antiphospholipid antibody syndrome (APS) pregnancies. A systematic review of the literature on additional treatments used in refractory and/or high-risk APS pregnancies was conducted. Records from February 2006 to October 2021 were retrieved from PubMed, Web of Science, Cochrane, and the www.clinicaltrials.gov platform. Twenty-one studies met our eligibility criteria. Live birth rate is this study’s primary endpoint, while pregnancy complications and adverse events are secondary endpoints. A total of 434 pregnancies, 162 (37.3%) refractory and 272 (62.7%) high-risk/refractory pregnancies, were included. Both IVIG <2 gr/kg/monthly/HCQ/LDS and PEX/IA ± LDS led to 100% viable infants in refractory APS. Furthermore, HCQ 200–400 mg showed a higher live birth rate than HCQ + LDS (88.6% vs. 82.7%). Following treatment protocol with HCQ 200–400 mg and IVIG <2 gr/kg/monthly/HCQ/LDS, pregnancy complications rates of 16.7 and 83.3% were registered, respectively. Pravastatin 20 mg, IA weekly + IVIG 2 gr/monthly, and PEX weekly + IVIg 2 gr/kg/monthly showed higher live birth rates in high-risk APS pregnancies of 100, 100 and 92%, respectively, whereas the lower severe pregnancy complications were reported in pregnancies treated with PEX weekly + IVIg 2 gr/kg/monthly (11.1%). One (0.6%) case of dermatitis during treatment with HCQ was observed. The results of this study showed that HCQ 200–400 mg and PEX weekly + IVIG 2 gr/kg/monthly achieved a higher live birth rate in refractory APS and high-risk/refractory APS, respectively. The results presented provide clinicians with up-to-date knowledge in the management of APS pregnancies according to risk stratification.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of Refractory/High-Risk Pregnancies With Antiphospholipid Syndrome: A Systematic Review of the Literature

Hoxha

Tormene²,

Campello³

et al. 2022

Front. Pharmacol.

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“…A meta-analysis demonstrated that triple positivity was associated with a lower probability of having live birth, increased risk of preeclampsia, and having a low birth weight for gestational age. In addition, aL-positive patients were at increased risk of preeclampsia and preterm delivery [ 41 ]. The same meta-analysis showed that a history of thrombosis was also associated with a lower likelihood of having live birth, increased neonatal mortality, increased risk of prenatal or postpartum thrombosis, and increased risk of having a newborn with low weight for gestational age [ 41 ].…”

Section: Reviewmentioning

confidence: 99%

“…In addition, aL-positive patients were at increased risk of preeclampsia and preterm delivery [ 41 ]. The same meta-analysis showed that a history of thrombosis was also associated with a lower likelihood of having live birth, increased neonatal mortality, increased risk of prenatal or postpartum thrombosis, and increased risk of having a newborn with low weight for gestational age [ 41 ]. Women negative for aL and with a single positive aCL or anti-β2GPI antibody result have a lower risk of adverse gestational outcomes, as do women with low antibody titers and positive IgM isotype results [ 42 , 43 ].…”

Section: Reviewmentioning

confidence: 99%

Obstetric Antiphospholipid Syndrome From the Perspective of a Rheumatologist

Santacruz¹,

Mantilla²,

Rueda³

et al. 2022

Cureus

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Antiphospholipid syndrome (APS) is an autoimmune disease that can lead to thrombotic or obstetric complications. Recent histopathological studies have shown the absence of placental thrombosis, leading to the consideration of other pathophysiological pathways such as inflammation and complement activation. Due to this, various clinical studies are being carried out with different drug agents in order to avoid their complications. The combination of prophylactic heparin treatment and low doses of aspirin today result in successful pregnancies in most cases. Despite this, a minority of patients require alternative therapies to avoid recurrent miscarriage and decrease obstetric morbidity. Thanks to the better understanding of its pathophysiology, other treatments such as low doses of glucocorticoids, hydroxychloroquine (HCQ), immunoglobulin, pravastatin, and plasmapheresis have been considered in refractory cases, achieving favorable results. Despite the great advances regarding its treatment, unfortunately, there are no treatments with a good level of evidence to reduce late obstetric complications. The evaluation of preconception risk factors, as well as the antiphospholipid antibody profile, is necessary to establish individual risk and thus anticipate possible complications.

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Successful pregnancies in a patient with Takayasu arteritis and antiphospholipid syndrome, maintained on infliximab corticosteroid-free regimen: case-based review

Jovicic,

Dragasevic,

Petkovic

et al. 2023

Rheumatol Int

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Pregnancy outcome predictors in antiphospholipid syndrome: A systematic review and meta-analysis

Cited by 48 publications

References 50 publications

Treatment of Refractory/High-Risk Pregnancies With Antiphospholipid Syndrome: A Systematic Review of the Literature

Treatment of Refractory/High-Risk Pregnancies With Antiphospholipid Syndrome: A Systematic Review of the Literature

Obstetric Antiphospholipid Syndrome From the Perspective of a Rheumatologist

Successful pregnancies in a patient with Takayasu arteritis and antiphospholipid syndrome, maintained on infliximab corticosteroid-free regimen: case-based review

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