Antiphospholipid Antibodies in Predicting Adverse Pregnancy Outcome: A Prospective Study

Abstract

Patients with elevated aPL levels at their initial prenatal visit had an increase in fetal loss but no increase in maternal pregnancy complications, low birth weight, or low Apgar scores. Immunoglobulin G anticardiolipin antibody was the only single test of aPL significantly associated with fetal loss.

Management of the obstetric antiphospholipid syndrome

“…This timing is relevant, because the later in pregnancy that this sample is obtained, the higher the chance that early losses are not taken into account when the outcome in women with aPL and those without aPL is compared. Despite these shortcomings and differences, all studies found lower live-birth rates in aPL-positive women (range 62-84%) than in aPL-negative women (range 90-98%) (28,(40)(41)(42) (Table 2). An association between the presence of aPL and severe preeclampsia was found in 2 studies (28,42), but not in another study (40).…”

“…Despite these shortcomings and differences, all studies found lower live-birth rates in aPL-positive women (range 62-84%) than in aPL-negative women (range 90-98%) (28,(40)(41)(42) (Table 2). An association between the presence of aPL and severe preeclampsia was found in 2 studies (28,42), but not in another study (40). The Yasuda et al study (42) found a negative association and the Lynch et al study (40) found a positive association between aPL and neonatal birth weight.…”

“…Four studies described the natural course of pregnancy related to aPL in women regarded as being at low risk for pregnancy complications (28,(40)(41)(42). Patients were defined as "a normal pregnancy population" (28), "women with no more than 2 consecutive abortions and no stillbirth" (41,40), and "absence of recurrent fetal wastage" (although women with fetal loss after 24 weeks of gestation were included) (42). Because all studies used results from a single blood sample to categorize women as positive or negative for aPL, by definition no patient met the serologic criteria for APS (7,14).…”

“…Because all studies used results from a single blood sample to categorize women as positive or negative for aPL, by definition no patient met the serologic criteria for APS (7,14). Other breaches of the criteria were testing for IgG aCL only (42) and the absence of a neutralization procedure (to confirm that the addition of extra phospholipids corrects abnormal coagulation times) in LAC tests (28,40,41). The studies included 16-95 women with aPL and 294-915 women negative for aPL (28,(40)(41)(42) (Table 2).…”

“…Other breaches of the criteria were testing for IgG aCL only (42) and the absence of a neutralization procedure (to confirm that the addition of extra phospholipids corrects abnormal coagulation times) in LAC tests (28,40,41). The studies included 16-95 women with aPL and 294-915 women negative for aPL (28,(40)(41)(42) (Table 2). The timing of blood sampling for aPL tests varied from the first antenatal visit (28) to 9 weeks (42), 13 weeks (40), and 16 weeks (41) of gestation.…”