Placental pathology in systemic lupus erythematosus and phospholipid antibody syndrome

Abstract

Clinicians have long appreciated that there is increased risk of poor pregnancy outcome in women with clinical or subclinical (i.e., serological) evidence of autoimmunity. The first report of medical complications related to a circulating anticoagulant was in 195217; its presence in patients with systemic lupus erythematosus (SLE) gave rise to the term lupus anticoagulant, which is in fact a misnomer, as this phenomenon is found in patients who may not have SLE. Additionally, it is not associated with an increased predisposition to bleeding but rather a prothrombotic diathesis. Since that time, investigators have attempted to unravel the relationship between SLE, phospholipid antibodies (aPL), (which include the lupus anticoagulant, anticardiolipin antibodies [aCL], and a biologically false-positive test for syphilis [Venereal Disease Research Laboratories] and pregnancy compromise. Numerous studies show that much of the pregnancy compromise associated with SLE appears to result from disease activityZ6, 28, 72 plus or minus the presence of phospholipid antibodies., 20, 21, 39. 41, 43, 47, 49 Preterm birth is more common in lupus pregnancie~.~~ Conversely, the presence of phospholipid antibodies and antiphospholipid antibody-related pregnancy loss may also be the herald of future maternal clinical disea~e.'~, 18, 29, 3n, 5n, 51 Bagger et a1 observed while investigating the degree of association between aCL and recurrent abortion or late fetal death with other signs of autoimmune disease (particularly SLE) that aCL-positive women with recurrent abortion or late fetal death have an increased occurrence of clinical