title: Prediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies.
abstract: OBJECTIVE
  To investigate which serologic and clinical findings predict adverse pregnancy outcome in patients with antiphospholipid antibody (aPL) and to test the hypothesis that a pattern of clinical and serologic variables can identify women at highest risk of adverse pregnancy outcome.
  
  
  METHODS
  Women enrolled in a multicenter prospective observational study of risk factors for adverse pregnancy outcome in patients with aPL (lupus anticoagulant [LAC], anticardiolipin antibody [aCL], and/or antibody to β2-glycoprotein I [anti-β2 GPI]) and/or systemic lupus erythematosus (SLE) were recruited for the present prospective study. Demographic, clinical, serologic, and treatment data were recorded at the time of the first study visit. The relationship between individual and combined variables and adverse pregnancy outcome was assessed by bivariate and multivariate analysis.
  
  
  RESULTS
  Between 2003 and 2011 we enrolled 144 pregnant patients, of whom 28 had adverse pregnancy outcome. Thirty-nine percent of the patients with LAC had adverse pregnancy outcome, compared to 3% of those who did not have LAC (P<0.0001). Among women with IgG aCL at a level of ≥40 units/ml, only 8% of those who were LAC negative had adverse pregnancy outcome, compared to 43% of those who were LAC positive (P=0.002). IgM aCL, IgG anti-β2 GPI, and IgM anti-β2 GPI did not predict adverse pregnancy outcome. In bivariate analysis, adverse pregnancy outcome occurred in 52% of patients with and 13% of patients without prior thrombosis (P=0.00005), and in 23% with SLE versus 17% without SLE (not significant); SLE was a predictor in multivariate analysis. Prior pregnancy loss did not predict adverse pregnancy outcome. Simultaneous positivity for aCL, anti-β2 GPI, and LAC did not predict adverse pregnancy outcome better than did positivity for LAC alone.
  
  
  CONCLUSIONS
  LAC is the primary predictor of adverse pregnancy outcome after 12 weeks' gestation in aPL-associated pregnancies. Anticardiolipin antibody and anti-β2 GPI, if LAC is not also present, do not predict adverse pregnancy outcome.
authors.affiliation: Hospital for Special Surgery and Weill Cornell Medical College, New York, New York. lockshinm@hss.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Lockshin
authors.forename: Mimi
authors.initials: M
authors.lastname: Kim
authors.forename: Carl A
authors.initials: CA
authors.lastname: Laskin
authors.forename: Marta
authors.initials: M
authors.lastname: Guerra
authors.forename: D Ware
authors.initials: DW
authors.lastname: Branch
authors.forename: Joan
authors.initials: J
authors.lastname: Merrill
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
authors.forename: T Flint
authors.initials: TF
authors.lastname: Porter
authors.forename: Lisa
authors.initials: L
authors.lastname: Sammaritano
authors.forename: Mary D
authors.initials: MD
authors.lastname: Stephenson
authors.forename: Jill
authors.initials: J
authors.lastname: Buyon
authors.forename: Jane E
authors.initials: JE
authors.lastname: Salmon
mesh_terms: D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood* / Q000276:immunology; D016736:Antiphospholipid Syndrome / Q000097:blood* / Q000276:immunology; D005260:Female; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood* / Q000276:immunology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000276:immunology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D017153:Antibodies, Anticardiolipin; D016682:Lupus Coagulation Inhibitor