title: Comparative incidence of pregnancy outcomes in treated obstetric antiphospholipid syndrome: the NOH-APS observational study.
abstract: The incidence of pregnancy outcomes for women with the purely obstetric form of antiphospholipid syndrome (APS) treated with prophylactic low-molecular-weight heparin (LMWH) plus low-dose aspirin (LDA) has not been documented. We observed women without a history of thrombosis who had experienced 3 consecutive spontaneous abortions before the 10th week of gestation or 1 fetal loss at or beyond the 10th week. We compared the frequencies of complications during new pregnancies between treated women with APS (n = 513; LMWH + LDA) and women negative for antiphospholipid antibodies as controls (n = 791; no treatment). Among APS women, prior fetal loss was a risk factor for fetal loss, preeclampsia (PE), premature birth, and the occurrence of any placenta-mediated complication. Being positive for anticardiolipin immunoglobulin M antibodies was a risk factor for any placenta-mediated complication. Among women with a history of recurrent abortion, APS women were at a higher risk than other women of PE, placenta-mediated complications, and neonatal mortality. Among women with prior fetal loss, LMWH + LDA-treated APS women had lower pregnancy loss rates but higher PE rates than other women. Improved therapies, in particular better prophylaxis of late pregnancy complications, are urgently needed for obstetric APS and should be evaluated according to the type of pregnancy loss.
authors.affiliation: Department of Hematology, University Hospital, Nîmes, France;
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bouvier
authors.forename: Eva
authors.initials: E
authors.lastname: Cochery-Nouvellon
authors.forename: Géraldine
authors.initials: G
authors.lastname: Lavigne-Lissalde
authors.forename: Erick
authors.initials: E
authors.lastname: Mercier
authors.forename: Tess
authors.initials: T
authors.lastname: Marchetti
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Balducchi
authors.forename: Pierre
authors.initials: P
authors.lastname: Marès
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Gris
mesh_terms: D000026:Abortion, Habitual / Q000453:epidemiology; D000022:Abortion, Spontaneous / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D016736:Antiphospholipid Syndrome / Q000453:epidemiology* / Q000628:therapy*; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007075:Immunoglobulin M / Q000737:chemistry; D010920:Placenta / Q000378:metabolism; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000628:therapy*; D011256:Pregnancy Outcome; D011379:Prognosis; D012307:Risk Factors; D055815:Young Adult
chemical_list: D017153:Antibodies, Anticardiolipin; D017152:Antibodies, Antiphospholipid; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D007075:Immunoglobulin M