title: Pathology findings in preterm placentas of women with autoantibodies: a case-control study.
abstract: OBJECTIVE
  To evaluate the placental histopathology findings in women with systemic lupus erythematosus or antiphospholipid syndrome delivered preterm.
  
  
  METHODS
  We performed a case-control study comparing clinical outcomes and placental histopathology of 18 consecutive singleton pregnancies with systemic lupus erythematosus (n = 9) or antiphospholipid syndrome (n = 9) delivered between 24 and 37 weeks, and 54 controls matched for gestational age and type of preterm delivery (spontaneous or indicated). Placental examinations were performed by a single pathologist, and placental lesions were grouped into four categories: uteroplacental vascular pathology and related villous lesions; coagulation-related damage; chronic inflammation; and acute inflammatory lesions. Statistical analysis included the Mantel-Haenzsel or Fisher's exact test, and logistic regression, with a value of p < 0.05 or an odds ratio (OR) with 95% confidence intervals (Cl) not inclusive of unity considered significant.
  
  
  RESULTS
  Lupus anticoagulant was positive in ten out of 18 cases and medium or high positive IgG anticardiolipin antibodies in seven out of 18. Antenatal treatment included corticosteroids (n = 9), low-dose aspirin (n = 15) and heparin (n = 8). Rates of necrotizing enterocolitis (33% vs. 0%, p < 0.001) and of perinatal mortality (33% vs. 9%, p = 0.02) were significantly different between cases and controls, and rates of birth weight < 10th centile approached statistical significance. Uteroplacental vascular lesions (OR 3.7, 95% CI 1.1, 11.7) and coagulation-related damage (OR 16.8, 95% CI 3.9, 72.6) were significantly more common among cases than controls, and rates of chronic inflammatory lesions approached significance.
  
  
  CONCLUSIONS
  Cases of systemic lupus erythematosus and antiphospholipid syndrome delivered preterm are associated with a significant increase in placental vascular and coagulation-related lesions, which are reflected clinically by higher rates of perinatal mortality, necrotizing enterocolitis, and small-for-gestational age neonates.
authors.affiliation: Department of Obstetrics and Gynecology, Istituto Scienze Biomediche San Gerardo, University of Milano-Bicocca, Monza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Locatelli
authors.forename: L
authors.initials: L
authors.lastname: Patané
authors.forename: A
authors.initials: A
authors.lastname: Ghidini
authors.forename: E
authors.initials: E
authors.lastname: Marinetti
authors.forename: A
authors.initials: A
authors.lastname: Zagarella
authors.forename: J C
authors.initials: JC
authors.lastname: Pezzullo
authors.forename: A
authors.initials: A
authors.lastname: Cappellini
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D016022:Case-Control Studies; D005260:Female; D005333:Fetus / Q000276:immunology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000276:immunology*; D007752:Obstetric Labor, Premature / Q000209:etiology; D010922:Placenta Diseases / Q000209:etiology / Q000276:immunology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology*; D011256:Pregnancy Outcome; D014652:Vascular Diseases / Q000209:etiology / Q000276:immunology*
chemical_list: D001323:Autoantibodies