Intrauterine fetal deaths related to antiphospholipid syndrome: a descriptive study of 65 women

Mériem Belhocine,Nathalie Costedoat-Chalumeau,Vassilis Tsatsaris,Laetitia Coutte,Emmanuelle Pannier,Claire Le Jeunne,Gaëlle Guettrot-Imbert,Odile Souchaud-Debouverie,Michel Dreyfus,Nicolas Martin Silva,Micaela Fredi,Véronique Le Guern,Jean-Charles Piette,Catherine Deneux-Tharaux,Nathalie Morel,Romain Paule

doi:10.1186/s13075-018-1745-2

Abstract

ObjectiveAlthough one of the three obstetric manifestations of antiphospholipid syndrome (APS) is intrauterine fetal death (IUFD), little is known about it in this context. We report the first large series of patients with APS and IUFD.MethodsWe retrospectively analyzed the history and clinical data of women at four French hospitals. All had (1) APS diagnosis (Sydney criteria) and (2) IUFD at or after 10 weeks of gestation (weeks) between 2000 and 2016.ResultsThe study included 65 women. Their median age at the index IUFD was 29 years (IQR 26–33); 38 (58%) were primigravidas. The index IUFD was the first APS clinical manifestation in 48 women (74%). Overall, 35% had a triple-positive antibody profile.IUFD occurred at a median gestational age of 24 weeks (IQR 18–27) and was associated with maternal obstetric complications in 16 women (25%), namely, preeclampsia (n = 12), hemolysis, elevated liver enzymes, and low platelet syndrome (HELLP) (n = 6), and/or placental abruption (n = 5). Half of the 50 women with available data had a small-for-gestational-age fetus.Overall, including during the follow-up period of 4 years (IQR 2–9), 28 women (43%) had at least one thrombosis, and 29% were diagnosed with systemic lupus erythematosus (SLE). Ultimately, 54 women (83%) had at least one live birth. Only one woman had three consecutive early miscarriages.ConclusionIUFD was most often the inaugural sign of APS. Of the APS classification criteria, IUFD, preeclampsia, and thromboses were common in this cohort, while the “3 consecutive early miscarriages” criterion was met only once. With treatment, most of the women successfully had at least one live birth.

Highlights

IntroductionA triple-positive aPL test or positive results for lupus anticoagulant (LA) alone put women at high risk of obstetric morbidity, including intrauterine fetal death (IUFD), the precise aPL antibody profiles of women with IUFD are unknown [3,4,5,6,7]
Antiphospholipid syndrome (APS) is defined by a combination of arterial and/or venous thrombosis, pregnancy morbidity, and persistent antiphospholipid antibodies, that is, lupus anticoagulant (LA), anticardiolipinBelhocine et al Arthritis Research & Therapy (2018) 20:249 a triple-positive aPL test or positive results for LA alone put women at high risk of obstetric morbidity, including intrauterine fetal death (IUFD), the precise aPL antibody profiles of women with IUFD are unknown [3,4,5,6,7]
We considered that women had been treated during pregnancy if they had been prescribed low-dose aspirin (LDA) and/or low-molecular-weight heparin (LMWH) before 12 weeks

Summary

Introduction

A triple-positive aPL test or positive results for LA alone put women at high risk of obstetric morbidity, including IUFD, the precise aPL antibody profiles of women with IUFD are unknown [3,4,5,6,7]. Available studies focus on reporting the prevalence of IUFD in APS, but no large dedicated series has described the clinical features of patients with APS and IUFD [8, 9]. Accurate data remain unavailable about the term at IUFD, the associated risks of thrombosis and of systemic lupus erythematosus (SLE), and the overall obstetric prognosis of these women with APS. To improve our knowledge of these issues, we retrospectively analyzed fetal deaths in a large series of women with APS, and we report on their thrombotic risk, development of SLE, and their success in child-bearing

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Discussion

Conclusion