title: The association between antiphospholipid antibodies and pregnancy morbidity, stroke, myocardial infarction, and deep vein thrombosis: a critical review of the literature.
abstract: In a previous systematic literature search, we demonstrated that the frequencies of antiphospholipid antibodies (aPL) in general-population patients with pregnancy morbidity (PM), deep vein thrombosis (DVT), myocardial infarction (MI), and stroke (ST) are 6%, 10%, 11%, and 14%. To determine the association between aPL and clinical outcomes, we conducted a follow-up analysis of the 120 studies included in the original paper. Based on the analysis of 81 studies, a significant difference in the frequency of aPL criteria tests between patients and controls emerged considering all the outcomes together (10% versus 3%). In particular, a significant difference was reported for overall PM, pregnancy loss (PrL), late PrL, severe preeclampsia (PEC), ST, MI, and DVT. No difference emerged for early PrL, intrauterine growth restriction (IUGR), PEC, eclampsia (EC), and HELLP. A positive association was found in more than half of the studies for overall PrL, severe PEC, HELLP, ST, MI, and DVT and in less than half for early and late PrL, PEC, EC, and IUGR. The positive association between aPL and clinical outcomes included in the antiphospholipid syndrome classification criteria is not supported by every study, being particularly inconsistent for early PL, IUGR, PEC, EC, and HELLP.
authors.affiliation: Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy cecilia.chighizola@unimi.it.
authors.forename: C B
authors.initials: CB
authors.lastname: Chighizola
authors.affiliation: Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Andreoli
authors.affiliation: Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: G Ramires
authors.initials: GR
authors.lastname: de Jesus
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Banzato
authors.affiliation: Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain.
authors.forename: G J
authors.initials: GJ
authors.lastname: Pons-Estel
authors.affiliation: Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, New York, NY, USA Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: D
authors.initials: D
authors.lastname: Erkan
mesh_terms: D000022:Abortion, Spontaneous / Q000276:immunology*; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D016736:Antiphospholipid Syndrome / Q000276:immunology; D005260:Female; D005317:Fetal Growth Retardation / Q000276:immunology; D006801:Humans; D016682:Lupus Coagulation Inhibitor; D009017:Morbidity; D009203:Myocardial Infarction / Q000276:immunology*; D011225:Pre-Eclampsia / Q000276:immunology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology*; D011256:Pregnancy Outcome; D020521:Stroke / Q000276:immunology*; D020246:Venous Thrombosis / Q000276:immunology*
chemical_list: D017152:Antibodies, Antiphospholipid; D016682:Lupus Coagulation Inhibitor
keywords: Antiphospholipid antibodies; antiphospholipid syndrome; epidemiology