Pregnancy failure in patients with obstetric antiphospholipid syndrome with conventional treatment: the influence of a triple positive antibody profile

Abstract

Conventional treatment of obstetric antiphospholipid syndrome fails in approximately 20-30% of pregnant women without any clearly identified risk factor. It is important to identify risk factors that are associated with these treatment failures. This study aimed to assess the impact of risk factors on pregnancy outcomes in women with obstetric antiphospholipid syndrome treated with conventional treatment. We carefully retrospectively selected 106 pregnancies in women with obstetric antiphospholipid syndrome treated with heparin + aspirin. Pregnancy outcomes were evaluated according to the following associated risk factors: triple positivity profile, double positivity profile, single positivity profile, history of thrombosis, autoimmune disease, more than four pregnancy losses, and high titers of anticardiolipin antibodies and/or anti-βeta-2-glycoprotein-I (aβ2GPI) antibodies. To establish the association between pregnancy outcomes and risk factors, a single binary logistic regressions analysis was performed. Risk factors associated with pregnancy loss with conventional treatment were: the presence of triple positivity (OR = 5.0, CI = 1.4-16.9, p = 0.01), high titers of aβ2GPI (OR = 4.4, CI = 1.2-16.1, p = 0.023) and a history of more than four pregnancy losses (OR = 3.5, CI = 1.2-10.0, p = 0.018). The presence of triple positivity was an independent risk factor associated with gestational complications (OR = 4.1, CI = 1.2-13.9, p = 0.02). Our findings reinforce the idea that triple positivity is a categorical risk factor for poor response to conventional treatment.

Antiphospholipid syndrome characteristics and adverse pregnancy outcomes after 20 weeks of pregnancy

“…The present finding that antibody composition did not represent a risk factor for specific adverse pregnancy outcomes among women with APS was also inconsistent with previous research . Several studies have suggested that antibody composition—primarily the triple‐positive profile—increases the risk of adverse pregnancy outcomes, even when women with APS receive appropriate treatment . The present study included only one patient who tested positive for all three autoantibodies; therefore, the effect of the triple‐positive profile could not be assessed.…”

“…These investigators used a composite outcome of fetal or neonatal loss, preterm delivery (≤32 weeks), and FGR. Latino et al . described the presence of high‐titer aβ2GP as a risk factor for adverse events, especially pregnancy loss.…”

“…Whether (and to what extent) different clinical and immunologic parameters are associated with an increased risk of adverse outcomes remains controversial. Various factors are reported to be associated with inferior pregnancy outcomes, including a high number of previous pregnancy losses, thrombotic APS, high antibody titer, and the number of different autoantibodies detected, specifically a triple‐positive profile …”

Pregnancy outcomes in patients with primary antiphospholipid syndrome

“…[17] The association of several antibody titer with pregnancy outcomes in APS women has further been shown. [18,19]…”

Link Between Pregnancy Outcomes and Anticardiolipin Antibody in Subjects with Abortus İmminens

“…Yapılan araştırmalarda antifosfolipidantikorlarının pozitifliği obstetrik komplikasyonların artışı ile ilişkili olduğu gösterilmiştir (15)(16)(17). Antifosfolipid antikor sendromu obstetrik fetal ölüm ve rekurren abortuslara neden olmaktadır (18).…”