Antiphospholipid antibodies and the risk of adverse pregnancy outcomes in patients with systemic lupus erythematosus: a systematic review and meta-analysis

ABSTRACT

Objective

This article aims to evaluate the magnitude of adverse pregnancy outcomes (APOs) risks associated with different antiphospholipid antibody (aPL) profiles in women with systemic lupus erythematosus (SLE).

Methods

Multiple databases were investigated to identify articles that explored the relationship between aPLs and APOs in SLE patients. A random effects model was used for calculating pooled odds ratios (OR). Stata version 15.0 was utilized to conduct the meta-analysis.

Results

There were 5234 patients involved in 30 studies. Overall aPL was linked to an increased incidence of any kind of APOs, fetal loss, and preterm birth. Any kind of APOs and preterm delivery were more common in patients with lupus anticoagulant (LA) positive. Anticardiolipin antibody (aCL) was associated with an increased risk of any kind of APOs and fetal loss. The association between aCL-IgM and fetal loss was also significant. Patients with anti-beta2-glycoprotein1 antibody (antiβ2GP1) positivity had an increased risk of fetal loss.

Conclusions

Both LA and aCL were risk factors of APOs in patients with SLE. Not only ACL, particularly aCL-IgM, but antiβ2GP1 were associated with an increased risk of fetal loss, while LA appeared to indicate the risk of preterm birth.

PROSPERO (CRD42023388122).

KEYWORDS:

• Systemic lupus erythematosus
• antiphospholipid antibody
• adverse pregnancy outcome
• lupus anticoagulant
• anticardiolipin antibody
• meta-analysis

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

All authors participated in the study’s conception and design. Study selection and data collection were performed by J Huang, Q Zhu, B Wang, and H Wang. The analysis and interpretation of data were produced by J Huang, Z Xie, X Zhu. The initial draft of the manuscript was written by J Huang, Z Yang, and T Zhao. The final manuscript was reviewed and approved by all authors.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/1744666X.2024.2324005

Additional information

Funding

This work was supported by National Natural Science Foundation of China [grant number 82104798], Natural Science Foundation of Zhejiang Province [grant number LQ21H270005, LQ23H270007], General Scientific Research Project of Zhejiang Education Department [grant number 2022GJYY048, Y202248707], Zhejiang Provincial Administration of Chinese Medicine [grant number 2023ZL066], Scientific Research Projects of Zhejiang Chinese Medical University [grant number 2021RCZXZK04], and Science Youth Exploration Project of Zhejiang Chinese Medical University [grant number 2021JKZKTS018B].