Pregnancy Outcome In Antiphospholipid Syndrome Research Articles

Prevalence and pregnancy outcome in antiphospholipid syndrome: an observational study

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by vascular thrombosis, both arterial and venous, and recurrent spontaneous pregnancy loss due to circulating antiphospholipid antibodies (aPL) including anticardiolipin antibodies (aCL) and/or anti-glycoprotein I antibodies (anti-GPI). This observational study was conducted among antenatal women at OBG Department, IMS, and SUM Hospital, Bhubaneswar, over a year from March 2020 to 2021. Of 1260 cases, 25 were diagnosed with ALPA syndrome, with a prevalence rate of 1.98%. The most common age was 26-30 years (40%) with a mean age of 28.83 ± 3.26 years. The primary cause was recurrent 1st-trimester spontaneous miscarriage. Beta 2 glycoprotein antibody was most prevalent (40%). Significant associations were found in hypertensive and FGR APLA patients compared to non-hypertensive and non-FGR APLA patients. Hypertension and FGR occurred in 24% and 20% of APLA patients, respectively. Preterm delivery rate was higher (52%) in APLA syndrome, without significant association. B2GP antibody was linked to the lowest live birth rate, and highest rates of preeclampsia, IUGR, and stillbirth. Screening for B2GP antibodies is recommended for FGR and early onset preeclampsia cases with/without previous spontaneous pregnancy loss.

Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: A Cohort Management Study.

The current study evaluates the efficacy and safety of different treatment strategies for pregnant patients with antiphospholipid syndrome. One hundred twenty-seven consecutive pregnancies were assessed; 87 (68.5%) with a history of pregnancy morbidity alone were treated with prophylactic low molecular weight heparin (LMWH) + low-dose aspirin (LDA, 100 mg) (group I) and 40 (31.5%) with a history of thrombosis and/or severe pregnancy complications with therapeutic LMWH + LDA (group II). LMWH doses were increased throughout the pregnancies depending on the patients' weight gain, and treatment was switched to a more intensive one at the first sign of maternal/fetal complications. The study's primary outcome was live births. There were no significant differences in live birth rate between group I (95.4%) and group II (87.5%). Even fetal complication rate was similar in the two groups; group II nevertheless had a higher prevalence of maternal and neonatal complications (p = 0.0005 and p = 0.01, respectively) and registered a significantly lower gestational age at delivery and birth weight (p = 0.0001 and p = 0.0005, respectively). Two patients in group I switched to group II therapy, six patients in group II switched to a more intensive treatment strategy (weekly plasma exchange + fortnightly intravenous immunoglobulins in addition to therapeutic LMWH + LDA). The multivariate analysis uncovered that triple antiphospholipid antibodies positivity was an independent factor leading to a more intensive therapy. All eight switched patients achieved a live birth. Study results revealed that adjusted LMWH doses and switching therapy at first signs of severe pregnancy complications led to a high rate of live births in antiphospholipid syndrome patients.

Antiphospholipid syndrome: An update on risk factors for pregnancy outcome.

The optimal treatment of women with primary antiphospholipid syndrome (APS) is still debated. About 20-30% of women with APS remain unable to give birth to healthy neonates despite conventional treatment, consisting of prophylactic-dose heparin and low-dose aspirin. These cases are defined "refractory obstetric APS". The early identification of risk factors associated with poor pregnancy outcome could be the optimal strategy to establish criteria for additional therapies, such as hydroxychloroquine, steroids, intravenous immunoglobulin, and plasma exchange. The aim of the present study was to review current literature about risk factors for poor pregnancy outcome. The PubMed database was used to search for peer-reviewed original and review articles concerning risk factors for pregnancy outcome in APS from 1st January 1990 to 15th January 2018. History of pregnancy morbidity and/or thrombosis, the association with SLE and/or other autoimmune diseases are well known history-based predictive factors for obstetrical complications, such as miscarriage, maternal venous thromboembolism, intrauterine foetal demise, preeclampsia, and neonatal death. Moreover, laboratory findings associated with poor pregnancy outcome are:triple antiphospholipid antibodies aPL positivity, double aPL positivity, single aPL positivity, false-positive IgM for CMV, and hypocomplementemia. Triple positivity is confirmed as the most significant risk factor by a large body of evidence. Furthermore, the abnormal uterine arteries Doppler velocimetry results are confirmed to be strongly associated with poor pregnancy outcomes in APS. The good performance of the uterine arteries velocimetry, as a negative predictive factor, was reported by different studies. On the contrary, in case of abnormal uterine arteries results, the relevance of a careful surveillance is highlighted for the high risk of maternal-foetal complications. Nevertheless, this tool is a late indicator to suggest any additional treatments. In order to prevent obstetrical complications and establish the optimal combination therapy, the knowledge at preconception or at the beginning of pregnancy of risk factors associated with poor pregnancy outcome could be a crucial step for management and treatment of APS. In addition, in the preconception assessment a regimen with low-dose aspirin, folic acid, and vitamin D supplementation should be offered, and a treatment strategy has to be established (conventional vs additional therapy). In fact, additional treatment has to be tailored for each patient.

Bleeding complications and antithrombotic treatment in 264 pregnancies in antiphospholipid syndrome.

Purpose The purpose of this study was to evaluate the safety of antithrombotic treatments prescribed during pregnancy in patients with antiphospholipid syndrome (APS). Methods This international, multicenter study included two cohorts of patients: a retrospective French cohort and a prospective US cohort (PROMISSE study). Inclusion criteria were (1) APS (Sydney criteria), (2) live pregnancy at 12 weeks of gestation (WG) with (3) follow-up data until six weeks post-partum. According to APS standard of care, patients were treated with aspirin and/or low-molecular weight heparin (LMWH) at prophylactic (pure obstetric APS) or therapeutic doses (history of thrombosis). Major bleeding was defined as abnormal blood loss during the pregnancy and/or post-partum period requiring intervention for hemostasis or transfusion, or during the peripartum period greater than 500 mL and/or requiring surgery or transfusion. Other bleeding events were classified as minor. Results Two hundred and sixty-four pregnancies (87 prospectively collected) in 204 patients were included (46% with history of thrombosis, 23% with associated systemic lupus). During pregnancy, treatment included LMWH ( n = 253; 96%) or low-dose aspirin ( n = 223; 84%), and 215 (81%) patients received both therapies. The live birth rate was 89% and 82% in the retrospective and prospective cohorts, respectively. Adverse pregnancy outcomes occurred in 28% of the retrospective cohort and in 40% of the prospective cohort. No maternal death was observed in either cohort. A combined total of 45 hemorrhagic events (25%) occurred in the retrospective cohort, but major bleeding was reported in only six pregnancies (3%). Neither heparin nor aspirin alone nor combined therapy increased the risk of hemorrhage. We also did not observe an increased rate of bleeding in the case of a short interval between last LMWH (less than 24 hours) or aspirin (less than five days) doses and delivery. Only emergency Caesarean section was significantly associated with an increased risk of bleeding (odds ratio (OR) 5.03 (1.41-17.96); p=.016). In the prospective cohort, only one minor bleeding event was reported (vaginal bleeding). Conclusion Our findings support the safety of antithrombotic therapy with aspirin and/or LMWH during pregnancy in high-risk women with APS, and highlight the need for better treatments to improve pregnancy outcomes in APS. PROMISSE Study ClinicalTrials.gov identifier: NCT00198068.

Pregnancy outcomes in antiphospholipid syndrome in a tertiary hospital: An observational study

Pregnancy outcomes in antiphospholipid syndrome in a tertiary hospital: An observational study

Predictors of Pregnancy Outcome in Antiphospholipid Syndrome: A Review

Background: The 20-30% of women with antiphospholipid syndrome (APS) remains unable to give birth to healthy neonates despite the conventional treatment. The purpose of this review is to summarize literature on the predictors of poor pregnancy outcome in women affected by APS. Results: History of pregnancy morbidity and/or thrombosis and the association with SLE are well known historybased predictive factors for pregnancy failure in women with APS. Moreover, laboratory findings associated with unsuccessful pregnancy outcome are lupus anticoagulant positivity, triple antiphospholipid antibodies (aPL) positivity, false-positive IgM for CMV and hypocomplementemia. The abnormal uterine arteries Doppler velocimetry results are confirmed to be strongly associated with poor maternal and feto-neonatal outcomes in APS pregnancies. Conclusion: To correctly explore and identify these clinical and laboratory variables associated with pregnancy failure is a critical step in aiding clinicians to manage and counsel the women with APS. Finding the optimal combination therapy according to these risk factors to prevent the main maternal and feto-neonatal complications in APS pregnancies is warranted.

In vivo in uterus non-invasive methods to predict placental insufficiency and adverse pregnancy outcomes in antiphospholipid syndrome

In vivo in uterus non-invasive methods to predict placental insufficiency and adverse pregnancy outcomes in antiphospholipid syndrome

Anti‐β2 glycoprotein I antibodies and pregnancy outcome in antiphospholipid syndrome

The relation between pregnancy outcome and single- or double-positivity of anticardiolipin (aCL) and β2 glycoprotein I (aβ2GPI) in antiphospholipid syndrome (APS) has yet to be clearly documented. In this article, a total of 191 lupus anticoagulant-negative pregnant women with primary APS were retrospectively divided into three groups: aCL(+) /aβ2GPI(-) ; aCL(+) /aβ2GPI(+) ; aCL(-) /aβ2GPI(+) . All women had received medical therapy consisting of prednisone (10-15 mg/day), low-dose aspirin (50 mg/day), and low molecular weight heparin (40 mg/day). The miscarriage rate in the double-positive group was significantly higher than that in the aCL(+) /aβ2GPI(-) group (46.2% vs. 22.1%, p < 0.05); the miscarriage rate in the aCL(-) /aβ2GPI(+) group (36.4%) was not significantly different from the rates of the other two groups (p > 0.05). Thus, double-positivity may be a risk factor for pregnancy loss and aβ2GPI antibody may be a better prognostic marker than aCL antibody for pregnancy outcome.

Systemic autoimmune disorders and pregnancy

The coincidence of systemic autoimmune diseases and pregnancy may modify the outcome of the disease and the pregnancy due to the background immunologic and hormonal processes. The great majority of patients with autoimmune diseases are young females in their reproductive years, willing to have babies. Consequently, we have to prepare for this special situation. Our concept on childbearing in autoimmune women has changed within the last 30 years. Earlier, systemic lupus erythematosus flared in about 50% of patients during pregnancy, but the flare rate has significantly decreased recently. This improvement can be attributed to increased attention to low diseases activity at the time of conception, which might reduce to the half of the risk for flare. Tight control of patients and appropriate use of corticosteroids also contribute to the better results. The adequate use of anti-thrombotic agents resulted in a significant amelioration of pregnancy outcome in antiphospholipid syndrome. The earlier use of methotrexate and the introduction of tumor necrosis factor-alpha inhibitors in the treatment of rheumatoid arthritis have changed the natural characteristics of the disease. The increase in remission rate indirectly has beneficial effect on the number of planned and carried out pregnancies. Authors review the connection between systemic autoimmune disorders and pregnancy as well as the possibilities of medical treatment of such diseases during pregnancy.

Predictors of Pregnancy Outcome in Antiphospholipid Syndrome: A Review

In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk of preeclampsia, fetal intrauterine growth restriction, and other complications related to uteroplacental insufficiency. In the last two decades, several studies were performed to identify the predictive role of some parameters in relation to obstetric outcome in APS patients. Among these, the uterine velocimetry Doppler is the most studied. It provides a non-invasive method for the study of uteroplacental blood flow, being able to detect a condition of impaired placental perfusion, due to the presence of circulating antiphospholipid antibodies (aPL). To date, the uterine artery Doppler velocimetry resulted to be a useful tool to identify APS pregnancies at higher risk of adverse pregnancy outcome. False-positive IgM for toxoplasmosis, others, rubella, cytomegalovirus, herpes viruses (TORCH) complex is associated to a worse pregnancy outcome because it reflects a dysregulation of the immune system which may amplify placental autoimmune damage. Moreover low levels of complement components are related to an increased incidence of obstetrical complications, suggesting that placental deposition of immune complexes and activation of complement cascade may contribute to placental failure APS related. The abnormal uterine Doppler velocimetry, false-positive TORCH IgM and low levels of complement components can be considered prognostic indexes of poor pregnancy outcome in APS.

Effect of heparin plus aspirin on pregnant outcome in women with antiphospholipid syndrome

目的 探讨肝素配伍小剂量阿斯匹林治疗妊娠合并原发性抗磷脂综合征(antiphospholipid syndrome,APS)对妊娠结局的影响. 方法回顾性分析320例不明原因的反复妊娠丢失的妇女,排除其它常见原因后,进行抗心磷脂抗体(anticardiolipin antibody,aCL)IgG、IgM测定,36例阳性者接受肝素配伍小剂量阿斯匹林治疗.结果36例患者中34例获活婴,死胎1例,流产1例,妊娠成功率为94.4%,孕周(35.7±3.2)周.新生儿体重为(2960±458)g,较同期相同孕周新生儿体重(2684±324)g明显增加(P＜0.05).结论肝素配伍小剂量阿斯匹林治疗APS可明显改善妊娠结局,为治疗妊娠合并原发性APS的有效方法。

Complement C5a receptors and neutrophils mediate fetal injury in the antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is defined by recurrent pregnancy loss and thrombosis in the presence of antiphospholipid (aPL) Ab's. Currently, therapy for pregnant women with APS is focused on preventing thrombosis, but anticoagulation is only partially successful in averting miscarriage. We hypothesized that complement activation is a central mechanism of pregnancy loss in APS and tested this in a model in which pregnant mice receive human IgG containing aPL Ab's. Here we identify complement component C5 (and particularly its cleavage product C5a) and neutrophils as key mediators of fetal injury, and we show that Ab's or peptides that block C5a-C5a receptor interactions prevent pregnancy complications. The fact that F(ab)'2 fragments of aPL Ab's do not mediate fetal injury and that C4-deficient mice are protected from fetal injury suggests that activation of the complement cascade is initiated via the classical pathway. Studies in factor B-deficient mice, however, indicate that alternative pathway activation is required and amplifies complement activation. In contrast, activating Fc gamma Rs do not play an important role in mediating aPL Ab-induced fetal injury. Our findings identify the key innate immune effectors engaged by pathogenic autoantibodies that mediate poor pregnancy outcomes in APS and provide novel and important targets for prevention of pregnancy loss in APS.