Clinical feature and anti-phospholipid antibody profiles of pregnancy failure in young women with antiphospholipid antibody syndrome treated with conventional therapy

Abstract

Objective: To elucidate clinical feature and anti-phospholipid antibody (aPL) profiles, including lupus anticoagulant (LA), anti-cardiolipin (CL) antibodies and anti-phosphatidylserine/prothrombin (PS/PT) antibodies, of pregnancy failure in patients with antiphospholipid antibody syndrome (APS) already treated with conventional therapy.

Materials and methods: Thirty-four women with a history of pregnancy who were diagnosed with APS between 2008 and 2016 were included in the study. We defined the successful pregnancy group as women who gave birth to a healthy baby over 1500 g after 34 weeks of pregnancy under conventional treatment (heparin and/or low-dose aspirin). The unsuccessful pregnancy group was defined as women whose pregnancy outcomes did not meet the aforementioned criteria despite the conventional therapy. The clinical features and aPL profiles were compared between the two groups.

Results: Fifteen women were classified into the unsuccessful pregnancy group; seven women were in the successful pregnancy group. Having history of both thrombosis and pregnancy morbidity and LA positivity were significantly more prevalent in the unsuccessful pregnancy group than in the successful pregnancy group (p <.05, respectively). In contrast, single positivity of anti-CL antibody was negatively associated with APS-associated pregnancy morbidity under the conventional treatment (p <.01). The proportion of anti-PS/PT IgG-positive patients was significantly higher in the unsuccessful pregnancy group (p = .02, OR 18.7, 95% CI 1.50, 232.29) with high concordance rate with LA (97% consistence).

Conclusion: History of both thrombosis and pregnancy morbidity and the positivity of LA and/or anti-PS/PT-IgG, not but anti-CL-antibodies were correlated with APS-associated pregnancy morbidity refractory to conventional treatment. Clinical feature and aPL profiles might help us to make risk assessment for adverse pregnancy outcomes in patients with APS.

Keywords:

• Antiphospholipid antibodies
• antiphospholipid syndrome
• lupus anticoagulant
• phosphatidylserine/prothrombin antibody
• pregnancy failure

Acknowledgements

We would like to thank Mariko Takagai and Hiromi Ono for the preservation and management of collected serum samples.

Conflict of interest

Tatsuya Atsumi received research grants/honoraria from Astellas Pharma Co. Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co. Ltd., TEIJIN PHARMA Ltd., Pfizer Inc., Takeda Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Co. Ltd., Daiichi Sankyo Co. Ltd., Japan Blood Products Organization., AYUMI Pharmaceutical Co. Ltd. The other authors have no conflicts of interest to declare.

Additional information

Funding

This work was supported in part by a grant from the Japan Ministry of Health, Labor and Welfare (MHLW) [#H25-Jisedai-Ippan-005].