title: Non-conventional antiphospholipid antibodies in patients with clinical obstetrical APS: Prevalence and treatment efficacy in pregnancies.
abstract: To describe the prevalence of non-conventional APL in patients with obstetrical APS without conventional APL and the impact of treatment on pregnancy outcome.
  
  
  
  Patients with clinical obstetrical criteria were tested for anti-phosphatidylethanolamine (aPE) IgG/M, anti-prothrombin/phosphatidylserine (anti-PS/PT) IgG/M, and anti-annexin V IgG. Pregnancy losses rates were compared between APS, non-conventional APS, and non-APL and in untreated pregnancies to treated ones for each group.
  
  
  
  Using the cutoffs (ROC), 65/96 (68%) patients have been considered as non-conventional APS and compared to 83 APS and 31 patients without APL. The obstetrical history in non-conventional APS did not differ in comparison to confirmed APS. The frequencies of anti-annexin V IgG antibodies tended to be more frequent in non-conventional APS (88% versus 73%; p = 0.06), and those of anti-PE IgG and M were similar. The anti-PS/PT IgG and M antibodies were more frequent in confirmed APS than in non-conventional APS (63% and 37% versus 4% and 5%, respectively, p < 0.0001). Overall, 261 pregnancies in patients with non-conventional APS were compared with 81 pregnancies of confirmed APS and 132 pregnancies from non-APL group. Out of 474, 136 (29%) patients have been treated during pregnancies, and treatment significantly increased the rate of live birth (26% in untreated versus 72% in treated pregnancies, p < 0.0001). In univariate analyses, treatment effect on pregnancy losses was similar in patients with APS and non-conventional APS, with odds ratio at 3.3 (95% CI: 1.8-6.1) and 6.9 (95% CI: 3.9-12.3) (p = 0.49) and significantly more important for the 2 APS groups pooled versus non-APL group [OR at 1.9 (95% CI: 1.1-3.5) for non-APL group versus 5.3 (95% CI: 3.5-8.1) for APS groups, p = 0.0025].
  
  
  
  In this study, 68% of patients with clinical criteria for obstetrical APS seronegative for conventional APL have non-conventional APL. These patients have a significant decrement of pregnancy losses if they receive treatment for APS during their pregnancy.
authors.affiliation: AP-HP, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Saint-Antoine, Sorbonne Universités, UPMC University Paris 06, F-75012, Paris, France. Electronic address: arsene.mekinian@aphp.fr.
authors.forename: Arsène
authors.initials: A
authors.lastname: Mekinian
authors.affiliation: AP-HP, Unité Fonctionnelles d'Immunologie, Auto-Immunité et Hypersensibilités, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Marie-Charlotte
authors.initials: MC
authors.lastname: Bourrienne
authors.affiliation: AP-HP, Service de Gynécologie-Obstétrique, Hôpital Jean Verdier, Université Paris 13, Bondy, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Carbillon
authors.affiliation: AP-HP, Service de Gynécologie-Obstétrique, Hôpital Jean Verdier, Université Paris 13, Bondy, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Benbara
authors.affiliation: AP-HP, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Saint-Antoine, Sorbonne Universités, UPMC University Paris 06, F-75012, Paris, France.
authors.forename: Abisror
authors.initials: A
authors.lastname: Noémie
authors.affiliation: AP-HP, Unité Fonctionnelles d'Immunologie, Auto-Immunité et Hypersensibilités, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chollet-Martin
authors.affiliation: AP-HP, Service de Gynécologie-Obstétrique, Hôpital Jean Verdier, Université Paris 13, Bondy, France.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Tigaizin
authors.affiliation: eXYSTAT, Malakoff, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Montestruc
authors.affiliation: AP-HP, Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Saint-Antoine, Sorbonne Universités, UPMC University Paris 06, F-75012, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
authors.affiliation: AP-HP, Unité Fonctionnelles d'Immunologie, Auto-Immunité et Hypersensibilités, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Nicaise-Roland
mesh_terms: D000328:Adult; D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D011256:Pregnancy Outcome; D015995:Prevalence; D016896:Treatment Outcome
chemical_list: D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D001241:Aspirin
keywords: Antiphospholipid syndrome; Non-conventional antiphospholipids; Obstetrical complications; Pregnancies treatment