Observational study of pregnant women with a previous spontaneous abortion before the 10th gestation week with and without antiphospholipid antibodies

J Thromb Haemost. 2010 Apr;8(4):699-706. doi: 10.1111/j.1538-7836.2010.03747.x. Epub 2010 Jan 17.

Abstract

Background: A clinical subtype of purely obstetrical antiphospholipid antibody (aPL-Ab) syndrome (APS) requires three or more unexplained consecutive embryonic losses before the 10th week of gestation associated with persistently positive lupus anticoagulant (LAC), and/or anticardiolipin IgG or IgM, and/or anti-beta2-glycoprotein I (abeta2GpI) IgG or IgM. Although this diagnostic classification of APS appeared to be the most sensitive, the APS-associated serological criteria are still debated.

Patients/methods: We prospectively observed the second pregnancy of 284 women with a previous embryonic loss, both with and without aPL-Ab.

Results: aPL-Ab-positive women were more prone to pregnancy loss, embryonic loss, pre-eclampsia, placental abruption and intrauterine fetal growth restriction. Type IIa aPL-Ab positivity (LAC present alone) was associated with the highest risk of recurrent embryonic loss and intrauterine growth restriction. Type I aPL-Ab positivity (combinations of aPL-Ab type positivity) was associated with the strongest risks of late complications, pre-eclampsia and placental abruption. Finally, abeta2GpI-M positivities were not clinically relevant in these women.

Conclusion: Patients with a first unexplained pregnancy loss before the 10th week of gestation who are also positive for aPL-Abs have a higher risk of various complications in their second pregnancy. In this study, measurement of abeta2GpI-M had a questionable prognostic value.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Spontaneous / immunology*
  • Abruptio Placentae / immunology
  • Adult
  • Antibodies, Anticardiolipin / blood
  • Antibodies, Antiphospholipid / blood*
  • Antiphospholipid Syndrome / complications
  • Antiphospholipid Syndrome / immunology*
  • Case-Control Studies
  • Chi-Square Distribution
  • Embryo Loss / immunology
  • Female
  • Fetal Growth Retardation / immunology
  • Gestational Age
  • Humans
  • Logistic Models
  • Lupus Coagulation Inhibitor / blood
  • Odds Ratio
  • Pre-Eclampsia / immunology
  • Pregnancy
  • Pregnancy Complications / immunology*
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Young Adult
  • beta 2-Glycoprotein I / immunology

Substances

  • Antibodies, Anticardiolipin
  • Antibodies, Antiphospholipid
  • Lupus Coagulation Inhibitor
  • beta 2-Glycoprotein I