Anticardiolipin Positivity Is Highly Associated With Intrauterine Growth Restriction in Women With Antiphospholipid Syndrome

Abstract

The purpose of our study was to evaluate pregnancy outcomes of women with antiphospholipid antibodies (aPL) positivity and assess risk factors associated with adverse pregnancy outcomes. Pregnant women with aPL positivity were enrolled prospectively in China from January 2017 to March 2020. Treatment of low-dose aspirin and low molecular weight heparin were given. Pregnancy outcomes and coagulation function were recorded and compared with normal pregnancies. Multivariable logistic regression was performed to identify risk factors associated to intrauterine growth restriction (IUGR). 270 pregnant women, including 44 diagnosed as Antiphospholipid syndrome (APS), 91 as non-criteria APS (NCAPS) and 135 normal cases as control, were enrolled in the study. The live birth rate in aPL carriers and APS group was 97% and 95.5%, respectively. Adverse pregnancy outcomes did not show significant difference between aPL carriers and normal pregnancies, and between APS and NCAPS, except for IUGR. The incidence of IUGR was significantly higher in aPL carriers than normal pregnancies, and in APS patients than NCAPS (P < 0.05). After controlling for age, in vitro fertilization (IVF), pregnancy losses related to APS and treatment, anticardiolipin (aCL) positivity was the only variable significantly associated with IUGR, with an adjusted odds ratio of 4.601 (95% CI, 1.205-17.573). Better pregnant outcomes of aPL positive women, include APS and NCAPS, were achieved in our study with treatment based on low-dose aspirin (LDA) plus low molecular weight heparin (LMWH). The incidence of IUGR was still higher in them, and aCL positivity was the only one risk factor associated with IUGR.

Comparing pregnancy outcomes in patients with criteria and non-criteria autoimmune disease: A systematic review

“…Two studies compared APO in ncAPS and HC with inconclusive results. While one reported a similar rate of APO between groups (24), another study concluded that ncAPS patients had an increased risk of pregnancy complications compared to healthy pregnant women (25). Despite the limited information in terms of APO between ncAPS and HC, the overall rate of APO in both ncAPS and APS groups was higher than expected from the general comparator population of each study (26)(27)(28).…”

“…low 19,22,25 quality evidence, described similar rates of pregnancy outcomes between ncAPS and APS groups after standard and non-standard APS treatments, whilst other two with very low 23 and low 24 quality of evidence did not. Less conclusive is the information about the rate of APO in ncAPS and APS patients before APS treatment.…”

“…3) of pregnancy outcomes in ncAPS with 1/8 'moderate', 6/8 'low' and 1/8 'very low' quality of evidence according to GRADE. They included 6 cohort and 2 case-control studies (11,(19)(20)(21)(22)(23)(24)(25).…”

“…Eight studies compared pregnancy outcomes in (n=1042) ncAPS patients with (n=1396) APS and/or (n=920) HC (11,(19)(20)(21)(22)(23)(24)(25). The largest (multicentre, mixed retrospective and prospective) study from the European Registry on Obstetric Antiphospholipid Antibody Syndrome (EUROAPS) examined 1640 (n=640 ncAPS and n=1000 APS) patients (11).…”

“…There were 8/15 studies of ncAPS and 7/15 of UCTD with control groups of healthy pregnant women in 4/15 This study also reported a substantial improvement in pregnancy and neonatal outcomes in both groups after standard and non-standard APS treatment [recurrent early miscarriage (0 vs 0%), stillbirth (6 vs 0%), preeclampsia (3 vs 0%) and IUGR (3 vs 12%)], as well as that the total number of obstetrical events per patient decreased significantly in both groups after treatment to reach an identical median value (from 3 [1][2][3][4][5][6][7][8] to 0 [0-2] in Group 1 (p < 0.05) and from 3 [1][2][3][4][5][6] to 0 [0-2] in Group 2 [p < 0.05]). A single centre prospective study 25 of 270 (n=91 ncAPS, n=41 APS and n=135 HC) patients did not show significant difference in APO between groups [stillbirth (2 vs 4.5 vs 0%), preterm birth (7 vs 14 vs 8%) and preeclampsia (10 vs 7 vs 13%)], except for the rate of IUGR (5.5 vs 16 vs 4%, p < 0.05) which was higher in both APS and ncAPS than healthy pregnant women. They also found that women with positivity for aPL (including APS and ncAPS patients) who were treated with LDA +/À an unspecified dose of LMWH achieved better pregnancy outcomes.…”