Elevated antiphospholipid antibody titers and adverse pregnancy outcomes: analysis of a population-based hospital dataset

James Nodler,Bahij S Nuwayhid,Elizabeth M Ledger,Surjit R Moolamalla,Zuber D Mulla

doi:10.1186/1471-2393-9-11

Abstract

BackgroundThe primary objective of this study was to determine if elevated antiphospholipid antibody titers were correlated with the presence of preeclampsia/eclampsia, systemic lupus erythematosus (SLE), placental insufficiency, and a prolonged length of stay (PLOS), in women who delivered throughout Florida, USA.MethodsCross-sectional analyses were conducted using a statewide hospital database. Prevalence odds ratios (OR) were calculated to quantify the association between elevated antiphospholipid antibody titers and four outcomes in 141,286 women who delivered in Florida in 2001. The possibility that the relationship between elevated antiphospholipid antibody titers and the outcomes of preeclampsia/eclampsia, placental insufficiency, and PLOS, may have been modified by the presence of SLE was evaluated in a multiple logistic regression model by creating a composite interaction term.ResultsWomen with elevated antiphospholipid antibody titers (n = 88) were older, more likely to be of white race and not on Medicaid than women who did not have elevated antiphospholipid antibody titers. Women who had elevated antiphospholipid antibody titers had an increased adjusted odds ratio for preeclampsia and eclampsia, (OR = 2.93 p = 0.0015), SLE (OR = 61.24 p < 0.0001), placental insufficiency (OR = 4.58 p = 0.0003), and PLOS (OR = 3.93 p < 0.0001). Patients who had both an elevated antiphospholipid antibody titer and SLE were significantly more likely than the comparison group (women without an elevated titer who did not have SLE) to have the outcomes of preeclampsia, placental insufficiency and PLOS.ConclusionThis exploratory epidemiologic investigation found moderate to very strong associations between elevated antiphospholipid antibody titers and four important outcomes in a large sample of women.

Highlights

The primary objective of this study was to determine if elevated antiphospholipid antibody titers were correlated with the presence of preeclampsia/eclampsia, systemic lupus erythematosus (SLE), placental insufficiency, and a prolonged length of stay (PLOS), in women who delivered throughout Florida, USA
These women were older and more likely to be of white race than women who did not have elevated AP antibody titers (Table 1)
Our statewide cross-sectional study revealed moderate to very strong associations between the risk factor of elevated AP antibody titers and four important outcomes in a large sample of women who delivered throughout Florida in calendar year 2001 (n = 141,286)

Summary

Introduction

The primary objective of this study was to determine if elevated antiphospholipid antibody titers were correlated with the presence of preeclampsia/eclampsia, systemic lupus erythematosus (SLE), placental insufficiency, and a prolonged length of stay (PLOS), in women who delivered throughout Florida, USA. The antiphospholipid syndrome (APS) is described as an autoimmune disorder defined by both clinical and laboratory criteria. Clinical criteria include vascular thrombosis as well as unexplained fetal death, preeclampsia, and eclampsia [1]. Laboratory criteria include the presence of medium to high titers of lupus anticoagulant, anticardiolipin, or anti-β2 glycoprotein-I antibodies [1]. Multiple medical and obstetric complications are commonly associated with APS such as preeclampsia, eclampsia, placental insufficiency, thrombocytopenia, stroke, transient ischemic attack, pulmonary embolism, livedo reticularis, Libman-Sacks endocarditis, multi-infarct dementia, migraine headache, transverse myelitis, cutaneous ulcers, venous thrombosis, and deep-vein thrombosis as well as other maladies [2,3,4,5]. Studies have shown that having SLE and APS puts one at higher risk for thrombosis than having either SLE or APS alone [3]

Objectives

Methods

Results

Discussion

Conclusion