The Association Between Antiphospholipid Antibodies and Adverse Pregnancy Outcomes: A Metaanalysis.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1819-1819
Author(s):  
Karim Abou-Nassar ◽  
Marc Carrier ◽  
Marc Rodger
Keyword(s):  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Placental Abruption ◽  
Fetal Loss ◽  
Anticardiolipin Antibodies ◽  
Adverse Pregnancy Outcomes ◽  
Clinical Criteria ◽  
Adverse Pregnancy

Abstract BACKGROUND: The Sapporo criteria for the diagnosis of the antiphospholipid syndrome (APS) are based on the presence of antiphospholipid antibodies (APLA) and clinical criteria. Although pre-eclampsia, intra-uterine growth restriction (IUGR), late fetal loss and placental abruption, collectively termed “placenta mediated complications”, are recognized as clinical criteria for the APS, their association with APLA remains controversial. OBJECTIVE: This review was conducted to evaluate the association between APLA (anticardiolipin antibodies, lupus anticoagulant, anti B2 glycoprotein 1 antibodies) and placenta mediated complications in untreated women without autoimmune diseases. METHODS: We performed a systematic review of published case-control, cohort and cross sectional studies using MEDLINE (1975 to October week 2 2007), EMBASE 16 (1980 to 2007 week 42) and all EBM Reviews (3rd quarter of 2007). For eligible studies, the rates of adverse pregnancy outcomes were compared between patients with and without specific APLA. Pooled odds ratios with 95% CI were generated using random-effects models. RESULTS: Our search strategy identified 1204 potentially relevant studies. Twenty five were included in the final analysis. Results are outlined in table 1. CONCLUSION: The association between various APLA and pregnancy complications is for the most part weak and inconsistent. There is currently insufficient data to support a significant link between anti-B2 glycoprotein 1 antibodies and pregnancy morbidity. Caution should be used when establishing a diagnosis of APS based on the presence of any APLA, particularly anti-B2 glycoprotein 1 antibodies, in the setting of late pregnancy complications. Table 1 Association Between APLA and Adverse Pregnancy Outcomes Pre-eclampsia OR (95%CI) # studies / participants IUGR OR (95%CI) # studies / participants Placental abruption OR (95%CI) # studies / participants Late fetal loss OR (95%CI) # studies / participants LA: Lupus anticoagulant; aCL: Anticardiolipin antibodies; Anti-B2 GP1 antibodies: Anti-B2 glycoprotein 1 antibodies italic characters indicate statistically significant associations LA 2.88 (1.42, 5.87)
 11 / 6085 3.51 (1.38, 8.93)
 4 / 3232 0.78 (0.13, 4.80)
 2 / 226 3.56 (0.12, 106.05)
 3 / 3870 aCL (IgG/IgM) 1.71 (1.09, 2.70)
 21 / 9722 2.31 (0.74, 7.17)
 6 / 5753 1.35 (0.45, 4.02)
 4 / 1274 3.86 (1.14, 13.07)
 7 / 5963 aCL IgG 1.65 (0.84, 3.22)
 15 / 3627 6.16 (2.50, 15.18)
 2 / 1006 1.87 (0.21, 16.83)
 2 / 500 10.06 (0.88, 114.96)
 2 / 1006 aCL IgM 1.36 (0.93, 1.97)
 13 / 5397 0.75 (0.19, 2.93)
 2 / 3002 0.96 (0.24, 3.85)
 2 / 500 1.37 (0.42, 4.46)
 3 / 3212 anti- B2GP1 (IgG/IgM) 2.97 (0.47, 18.69)
 4 / 2225 20.03 (4.59, 87.43)
 1 / 1108 2.64 (0.14, 50.63)
 1 / 510 6.74 (0.24, 191.23)
 3 / 1828 anti- B2GP1 IgG 0.87 (0.38, 2.01)
 2 / 607 N/A
 0 / 0 N/A
 0 / 0 0.52 (0.02, 11.02)
 1 / 212 anti- B2GP1 IgM 0.37 (0.16, 0.85)
 1 / 400 N/A
 0 / 0 N/A
 0 / 0 1.32 (0.24, 7.42)
 1 / 210

scholarly journals Low Preconception Complement Levels Are Associated with Adverse Pregnancy Outcomes in a Multicenter Study of 260 Pregnancies in 197 Women with Antiphospholipid Syndrome or Carriers of Antiphospholipid Antibodies

Biomedicines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 671
Author(s):  
Cecilia Nalli ◽  
Daniele Lini ◽  
Laura Andreoli ◽  
Francesca Crisafulli ◽  
Micaela Fredi ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Multicenter Study ◽  
Pregnancy Outcomes ◽  
Antiphospholipid Antibodies ◽  
Pregnancy Loss ◽  
Fetal Loss ◽  
Adverse Pregnancy Outcomes ◽  
Experimental Animal Models ◽  
Increased Risk ◽  
Adverse Pregnancy

Antiphospholipid antibodies (aPL) can induce fetal loss in experimental animal models. Human studies did find hypocomplementemia associated with pregnancy complications in patients with antiphospholipid syndrome (APS), but these results are not unanimously confirmed. To investigate if the detection of low C3/C4 could be considered a risk factor for adverse pregnancy outcomes (APO) in APS and aPL carriers’ pregnancies we performed a multicenter study including 503 pregnancies from 11 Italian and 1 Russian centers. Data in women with APS and asymptomatic carriers with persistently positive aPL and preconception complement levels were available for 260 pregnancies. In pregnancies with low preconception C3/C4, a significantly higher prevalence of pregnancy losses was observed (p = 0.008). A subgroup analysis focusing on triple aPL-positive patients found that preconception low C3 and/or C4 levels were associated with an increased rate of pregnancy loss (p = 0.05). Our findings confirm that decreased complement levels before pregnancy are associated with increased risk of APO. This has been seen only in women with triple aPL positivity, indeed single or double positivity does not show this trend. Complement levels are cheap and easy to be measured therefore they could represent a useful aid to identify patients at increased risk of pregnancy loss.

scholarly journals High risk of adverse pregnancy outcomes in women with a persistent lupus anticoagulant

2019 ◽  
Vol 3 (5) ◽  
pp. 769-776 ◽  
Author(s):  
Johanna Gebhart ◽  
Florian Posch ◽  
Silvia Koder ◽  
Peter Quehenberger ◽  
Thomas Perkmann ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Lupus Anticoagulant ◽  
Adverse Pregnancy Outcomes ◽  
Antiphospholipid Antibody ◽  
Childbearing Age ◽  
Elevated Liver Enzymes ◽  
Increased Risk ◽  
Adverse Pregnancy

Abstract Lupus anticoagulant (LA) has been associated with pregnancy complications and pregnancy loss. Identification of predictive factors could aid in deciding on therapeutic management. To identify risk factors for adverse pregnancy outcomes in high-risk women with persistently positive LA, we prospectively followed 82 women of childbearing age, of whom 23 had 40 pregnancies within the Vienna Lupus Anticoagulant and Thrombosis Study. Pregnancy complications occurred in 28/40 (70%) pregnancies, including 22 (55%) spontaneous abortions (<10th week of gestation [WOG]: n = 12, 10th to 24th WOG: n = 10) and 6 deliveries <34th WOG (15%, 3 due to severe preeclampsia/HELLP [hemolysis, elevated liver enzymes, and a low platelet count] syndrome, 3 due to placental insufficiency). One abortion was followed by catastrophic antiphospholipid syndrome. Neither a history of pregnancy complications nor of thrombosis, or prepregnancy antiphospholipid antibody levels were associated with adverse pregnancy outcomes. In logistic regression analysis, higher age was associated with a lower risk of adverse pregnancy outcome (per 5 years’ increase: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.19-0.87), a high Rosner index (index of circulating anticoagulant) predicted an increased risk (OR = 4.51, 95% CI: 1.08-18.93). Live birth rate was 15/28 (54%) in women on the combination of low-molecular-weight heparin and low-dose aspirin and 3/12 (25%) in those with no treatment or a single agent. We conclude that the risk of severe, even life-threatening pregnancy complications and adverse pregnancy outcomes is very high in women with persistent LA. A high Rosner index indicates an increased risk. Improved treatment options for women with persistently positive LA are urgently needed.

The Association Between Anti-beta2 Glycoprotein 1 Antibodies and Adverse Pregnancy Outcomes.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4003-4003 ◽  
Author(s):  
Karim Abou-Nassar ◽  
Mark Walker ◽  
Shi-Wu Wen ◽  
Marisa Freedman ◽  
Steve Doucette ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Placental Abruption ◽  
Fetal Loss ◽  
Adverse Pregnancy Outcomes ◽  
Enzyme Linked Immunosorbent Assay ◽  
Composite Outcome ◽  
Igm Antibodies ◽  
Increased Risk ◽  
Objective Evidence ◽  
Adverse Pregnancy

Abstract Abstract 4003 Poster Board III-939 BACKGROUND The Sapporo criteria include anti-β2 glycoprotein1 (anti-B2GP1) antibodies among antiphospholipid antibodies used to diagnose the antiphospholipid syndrome (APS). Although pre-eclampsia, intra-uterine growth restriction (IUGR), late fetal loss and placental abruption, collectively termed “placenta mediated complications”, are recognized as clinical criteria for the APS, strong evidence to support their association with anti-B2GP1 antibodies is lacking. OBJECTIVE This study aims to assess the association between anti-B2GP1 antibodies and placenta mediated complications. METHODS We performed a nested case-control study from a prospective cohort of 7000 mother baby pairs whereby women and their fetuses were recruited between 12-20 weeks gestation. Five hundred cases were randomly selected amongst women who experienced one of the following adjudicated adverse pregnancy outcomes: pre-eclampsia (BP ≥140/90 with proteinuria), placental abruption (antepartum bleeding with objective evidence of placental thrombus), late pregnancy loss (≥ 12 weeks gestation) and IUGR (birth weight less than the 10th percentile of normal population). Random selection of 500 controls was performed amongst women who did not experience the above mentioned adverse pregnancy outcomes. Stored blood samples were analyzed for the presence of anti-B2GP1 IgG and IgM antibodies by enzyme-linked immunosorbent assay. Titers ≥ than 20 G or M units were considered positive. This study has an 80% power to detect an odds ratio of 2.25 at the 5% level of significance based on an estimated 4 % prevalence of anti-B2GP1 IgG and/or IgM antibodies in titers ≥ 20 G/M units in our cohort of pregnant women. RESULTS Anti-B2GP1 IgG and/or IgM antibodies in titers ≥ 20 G/M units were present in 24/497 (4.8%) controls and 33/503 (6.6%) cases. The presence of anti-B2GP1 IgG and/or IgM in titers ' 20 G/M units was not significantly associated with a composite outcome of pre-eclampsia, IUGR, late fetal loss and placental abruption (OR 1.38; 95%CI 0.8-2.37 p=0.18). This combination of antibodies and titers only demonstrated a weak association with IUGR (OR 1.86; 95%CI 1.09-3.18 p=0.02). The presence of anti-B2GP1 IgG and/or IgM antibodies in titers ≥ 40 G/M units also failed to show an association with a composite outcome of pre-eclampsia, IUGR, late fetal loss and placental abruption (OR 2.65; 95%CI 0.7-10.04 p=0.15). However, stronger associations were observed with placental abruption (OR 4.87; 95%CI 1.02-23.25 p=0.047) and IUGR (OR 3.53; 95%CI 1.03-12.15 p=0.045). CONCLUSION The presence of anti-B2GP1 IgG and/or IgM antibodies in titers 20 ≥ G/M units during pregnancy is only associated with an increased risk of IUGR. Anti-B2GP1 antibodies in titers ' 40 G/M units, as suggested in the Sapporo diagnostic criteria for the APS, are associated with IUGR and placental abruption and possibly other placenta mediated complications. Larger adequately powered studies will be required to provide definitive answers. Disclosures: No relevant conflicts of interest to declare.

Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Tanapak Wisetmongkolchai ◽  
Fuanglada Tongprasert ◽  
Kasemsri Srisupundit ◽  
Suchaya Luewan ◽  
Kuntharee Traisrisilp ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Loss Rate ◽  
Fetal Loss ◽  
Adverse Pregnancy Outcomes ◽  
Expert Group ◽  
Second Trimester ◽  
Single Institution ◽  
Adverse Pregnancy ◽  
In Pregnancy ◽  
Singleton Pregnancies

AbstractObjectivesTo compare the rate of fetal loss in pregnancy after second trimester amniocentesis between procedures performed by experts and non-experts and to assess other pregnancy complications as secondary outcomes.MethodsA retrospective cohort study was performed on singleton pregnancies that underwent mid-trimester amniocenteses in a single institution. The fetal loss rates of procedures performed by experts and non-experts were collected and analyzed. Other adverse pregnancy outcomes were also examined.ResultsIn total, 14,450 amniocenteses were performed during the study period. These included 11,357 (78.6%) procedures in the group expert operators and 3,093 (21.4%) procedures in the group non-expert operators. In the non-expert group, the fetal loss rate was slightly increased but not significantly (p=0.24).In addition, the higher number of spontaneous abortions was associated with blood-stained amniotic fluid sample (p<0.001; RR=9.28). Multiple needle insertions also increased in the non-expert group significantly. However, no difference in pregnancy outcomes was found between in single and multiple needle insertions.ConclusionsThe amniocentesis procedures performed by the non-experts was not increase the fetal loss rate. However, the other adverse pregnancy outcomes, including preterm birth, low birth weight and fetal growth restriction were significantly increased in the non-expert group.

scholarly journals Effectiveness of Prenatal Vitamin D Deficiency Screening and Treatment Program: A Stratified Randomized Field Trial

2018 ◽  
Vol 103 (8) ◽  
pp. 2936-2948 ◽  
Author(s):  
Maryam Rostami ◽  
Fahimeh Ramezani Tehrani ◽  
Masoumeh Simbar ◽  
Razieh Bidhendi Yarandi ◽  
Sonia Minooee ◽  
...  
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Treatment Program ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Screening Program ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Adverse Pregnancy ◽  
Screening Site

Abstract Context Despite evidence on the association between hypovitaminosis D and adverse pregnancy outcomes and the positive impact of vitamin D supplementation, no evidence exists supporting a universal screening program in pregnancy as part of routine prenatal care. Objective We sought to determine the effectiveness of a prenatal screening program on optimizing 25-hydroxyvitamin D [25(OH)D] levels and preventing pregnancy complications. Also, to identify a safe regimen, we compared several regimens in a subgroup of vitamin D–deficient pregnant women. Design Two cities of Masjed-Soleyman and Shushtar from Khuzestan province, Iran, were selected as the screening and nonscreening arms, respectively. Within the screening arm, a randomized controlled trial was conducted on 800 pregnant women. Setting Health centers of Masjed-Soleyman and Shushtar cities. Patients or Participants Pregnant women aged 18 to 40 years. Intervention Women with moderate [25(OH)D, 10 to 20 ng/mL] and severe [25(OH)D, &lt;10 ng/mL] deficiency were randomly divided into four subgroups and received vitamin D3 (D3) until delivery. Main Outcome Measure Maternal concentration of 25(OH)D at delivery and rate of pregnancy complications Results After supplementation, only 2% of the women in the nonscreening site met the sufficiency level (&gt;20 ng/mL) vs 53% of the women in the screening site. Adverse pregnancy outcomes, including preeclampsia, gestational diabetes mellitus, and preterm delivery, were decreased by 60%, 50%, and 40%, respectively, in the screening site. A D3 injection in addition to monthly 50,000 IU maintenance therapy contributed the most to achievement of sufficient levels at delivery. Conclusions A prenatal vitamin D screening and treatment program is an effective approach in detecting deficient women, improving 25(OH)D levels, and decreasing pregnancy adverse outcomes.

scholarly journals Selected Micronutrients: An Option to Boost Immunity against COVID-19 and Prevent Adverse Pregnancy Outcomes in Pregnant Women: A Narrative Review

2020 ◽  
Author(s):  
NAWSHERWAN NAWSHERWAN ◽  
Suliman KHAN ◽  
Falak ZEB ◽  
Muhammad SHOAIB ◽  
Ghulam NABI ◽  
...  
Keyword(s):  
Immune System ◽  
Vitamin A ◽  
Pregnant Women ◽  
Immune Function ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Adverse Pregnancy Outcomes ◽  
Adequate Intake ◽  
Adverse Pregnancy

The coronavirus disease-19 (COVID-19) negatively affects immune system. It is linked with adverse pregnancy outcomes. These complications may be linked with the infections mediated deficiency of micronutrients in pregnant women. COVID-19 cause’s malabsorption of micronutrients thereby increases the risk of their deficiency. Both micronutrients deficiencies and poor micronutrients intake can compromise immune function and may increase the risk of pregnancy complications associated with COVID-19 infection. Vitamin A, C, D, E, and selected minerals iron (Fe), selenium (Se), and zinc (Zn) are the micronutrients essential for immuno-competency and play a significant role in the prevention of adverse pregnancy outcomes. Immune function and pregnancy outcomes can be improved by adequate intake of micronutrients in diet or in supplements form. Based on regulatory links between viral infection, micronutrients, immunity, and pregnancy outcomes, this review highlights the role of micronutrients in boosting immunity to reduce or prevent pregnancy complications in COVID-19 infected women.

Anticardiolipin Antibodies Block the Inhibition by β2-Glycoprotein I of the Factor Xa Generating Activity of Platelets

1993 ◽  
Vol 70 (02) ◽  
pp. 342-345 ◽  
Author(s):  
Wei Shi ◽  
Beng H Chong ◽  
Philip J Hogg ◽  
Colin N Chesterman
Keyword(s):  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Fetal Loss ◽  
Factor Xa ◽  
Anticardiolipin Antibodies ◽  
Recurrent Fetal Loss ◽  
Glycoprotein I ◽  
Activated Platelets ◽  
Inhibit Factor

SummaryAntiphospholipid antibodies, defined either by lupus anticoagulant (LA) activity or positive anticardiolipin immunoabsorbent assay (ACA) are associated with a predisposition to thromboses, recurrent fetal loss or thrombocytopenia. The mechanisms for these predispositions remain undefined. We have enriched immunoglobulin fractions from two patient plasmas to obtain antibodies with LA activity but no ACA, or conversely, with ACA positivity but no LA, in order to investigate in vitro characteristics which might explain a thrombotic propensity. β2-glycoprotein I (β2-GPI), the plasma cofactor required for ACA binding to negatively charged phospholipid, has previously been shown to inhibit prothrombinase generation in the presence of activated platelets (8). We now report that β2-GPI, at physiological concentrations, inhibits the generation of factor Xa in the presence of activated gel-filtered platelets. Further, ACA interferes with this inhibition, resulting in protracted, unopposed factor Xa generation. This interference with β2-GPI, a natural anticoagulant component of plasma, is potentially prothrombotic. LA immunoglobulins behave differently and inhibit factor Xa generation in a manner similar to β2-GPI. These findings provide the basis for a previously unsuspected mechanism for thrombosis in patients with aPL.

scholarly journals HYdroxychloroquine to Improve Pregnancy Outcome in Women with AnTIphospholipid Antibodies (HYPATIA) Protocol: A Multinational Randomized Controlled Trial of Hydroxychloroquine versus Placebo in Addition to Standard Treatment in Pregnant Women with Antiphospholipid Syndrome or Antibodies

2017 ◽  
Vol 43 (06) ◽  
pp. 562-571 ◽  
Author(s):  
Karen Schreiber ◽  
Karen Breen ◽  
Hannah Cohen ◽  
Soren Jacobsen ◽  
Saskia Middeldorp ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Antiphospholipid Antibodies ◽  
Pregnancy Loss ◽  
Standard Treatment ◽  
Randomized Controlled ◽  
Improve Pregnancy Outcome ◽  
Adverse Pregnancy

AbstractWomen with antiphospholipid antibodies (aPL) are at risk of adverse pregnancy outcomes, including recurrent first-trimester pregnancy loss and late pregnancy complications such as preeclampsia, HELLP (hemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, premature delivery, intrauterine growth restriction, placental abruption, and intrauterine death. Current standard care in obstetric antiphospholipid syndrome includes aspirin and heparin and has resulted in live-birth rates of approximately 70%. However, 30% continue to have pregnancy complications. Hydroxychloroquine (HCQ) is suggested as a new treatment approach, but no randomized controlled trials (RCTs) have assessed its efficacy. This study aims to assess pregnancy outcome in women with aPL treated with HCQ versus placebo in addition to standard treatment. The HYdroxychloroquine to improve Pregnancy outcome in women with AnTIphospholipid Antibodies (HYPATIA) study is a phase IV multicenter RCT, in which pregnant women with persistent aPL will receive either HCQ or placebo in addition to their usual medication. The primary endpoint is a composite of aPL-related adverse pregnancy outcomes: one or more pregnancy loss(es) (either < 10 or > 10 weeks of gestation) and premature birth before 34 weeks due to any of the following preeclampsia, eclampsia, or recognized features of placental insufficiency. The HYPATIA study is expected to provide evidence on the effect of HCQ in pregnant women with persistent aPL.

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