Abstract
Objective Antiphospholipid syndrome (APS) is a chronic autoimmune disease with a high prevalence in females. Published data have identified pregnant women with APS may suffer from recurrent miscarriage, fetal death. However, the association between antiphospholipid antibody (aPL) and fetal growth restriction (FGR) remains controversial. This study aims to systematically review the literature on population-based studies investigating an association between aPL and FGR. Methods The literature was searched on 1 November, 2021, using Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL), following the MOOSE checklist. Study inclusion criteria focused on peer-reviewed published articles that reported an association between aPL and FGR. Quality assessment was performed based on the Newcastle-Ottawa scale. The between-study heterogeneity was assessed by the Q test. Publication bias was assessed by funnel plots. Results Twenty-two studies (with 11745 pregnant women) were included in the final analysis. Pooled odds ratio for association of aPL, anticardiolipin antibodies (ACA), anti-beta2 glycoprotein 1 antibodies (β2GP1), and FGR was 1.26 (95%CI 1.12, 1.40), 2.25 (95%CI 1.55, 2.94), and 1.31 (95% CI 1.12, 1.49), respectively. Lupus anticoagulant (LA) did not increase the chance of FGR (OR 0.82, 95%CI 0.54, 1.10). Conclusions Our meta-analysis showed that aPL increased the risk of FGR. The risk of FGR varies with the aPL types. ACA and β2GP1 are strongly associated with FGR. There are currently insufficient data to support a significant relationship between LA and FGR.
Highlights
Antiphospholipid syndrome (APS) is an autoimmune condition, which may potentially cause adverse pregnancy outcomes. e current diagnosis of APS requires at least one laboratory and clinical criterion each [1]
Sample size varied from 38 to 1,616 women. e age of patients ranged from 25 to 41.5 years. e definition of fetal growth restriction (FGR) from eighteen studies was ultrasound estimated fetal weight less than 10th percentile for gestational age [7], and the definition of three studies was birthweight
Spegiorin et al reported that newborns born to mothers suffering from APS were associated with FGR and low birth weight [9]. e rate of FGR varied between 16.1% and 51.3% [40,41,42,43,44]. e morbidity and mortality associated with FGR and fetal death represent a significant disease burden for women and their children
Summary
Antiphospholipid syndrome (APS) is an autoimmune condition, which may potentially cause adverse pregnancy outcomes. e current diagnosis of APS requires at least one laboratory and clinical criterion each [1]. One of the clinical criteria includes the occurrence of one or more premature births of a morphologically normal neonate before the 34th week of gestation because of placental insufficiency. One of the features of placental insufficiency is fetal growth restriction (FGR), defined as a fetus that has not achieved his or her growth potential [2]. Some guidelines define FGR as ultrasound estimated fetal weight of less than 10th percentile for gestational age on the reference chart [2]. FGR is the result of a variety of different maternal, fetal, and placental conditions, resulting in severe perinatal mortality and morbidity [3]. Children born to mothers suffering from APS are associated to FGR and low birth weights, even
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