Observational study of pregnant women with a previous spontaneous abortion before the 10th gestation week with and without antiphospholipid antibodies.
BACKGROUND
A clinical subtype of purely obstetrical antiphospholipid antibody (aPL-Ab) syndrome (APS) requires three or more unexplained consecutive embryonic losses before the 10th week of gestation associated with persistently positive lupus anticoagulant (LAC), and/or anticardiolipin IgG or IgM, and/or anti-beta2-glycoprotein I (abeta2GpI) IgG or IgM. Although this diagnostic classification of APS appeared to be the most sensitive, the APS-associated serological criteria are still debated.


METHODS
We prospectively observed the second pregnancy of 284 women with a previous embryonic loss, both with and without aPL-Ab.


RESULTS
aPL-Ab-positive women were more prone to pregnancy loss, embryonic loss, pre-eclampsia, placental abruption and intrauterine fetal growth restriction. Type IIa aPL-Ab positivity (LAC present alone) was associated with the highest risk of recurrent embryonic loss and intrauterine growth restriction. Type I aPL-Ab positivity (combinations of aPL-Ab type positivity) was associated with the strongest risks of late complications, pre-eclampsia and placental abruption. Finally, abeta2GpI-M positivities were not clinically relevant in these women.


CONCLUSIONS
Patients with a first unexplained pregnancy loss before the 10th week of gestation who are also positive for aPL-Abs have a higher risk of various complications in their second pregnancy. In this study, measurement of abeta2GpI-M had a questionable prognostic value.
Chauleur
C
C
Research Team EA2992, Montpellier University 1, Nîmes, France.
Galanaud
J-P
JP
Alonso
S
S
Cochery-Nouvellon
E
E
Balducchi
J-P
JP
Marès
P
P
Fabbro-Peray
P
P
Gris
J-C
JC
D000022:Abortion, Spontaneous / Q000276:immunology*; D000037:Abruptio Placentae / Q000276:immunology; D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000276:immunology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D020964:Embryo Loss / Q000276:immunology; D005260:Female; D005317:Fetal Growth Retardation / Q000276:immunology; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000276:immunology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult; D053482:beta 2-Glycoprotein I / Q000276:immunology
D017153:Antibodies, Anticardiolipin; D017152:Antibodies, Antiphospholipid; D016682:Lupus Coagulation Inhibitor; D053482:beta 2-Glycoprotein I