Protein S deficiency complicated pregnancy in women with recurrent pregnancy loss

Abstract

This prospective study aimed to evaluate pregnancy outcome and complications in women with recurrent pregnancy loss (RPL) and protein S (PS) deficiency, who received low dose aspirin (LDA) or LDA plus heparin (LDA/H) therapies. Clinical characteristics, pregnancy outcome and complications of 38 women with two or more RPL and <60% of plasma free PS antigen were compared among three groups: antiphospholipid antibody (aPL)-negative women who received LDA (group A), aPL-negative women who received LDA/H (group B) and aPL-positive women who received LDA/H (group C). Gestational weeks (GW) at delivery in group C (median 32 GW) were earlier than 40 GW in group A and 38.5 GW in group B (p < 0.05). The birth weight in group C (median 1794 g) was less than 2855 g in group B (p < 0.05). The incidences of fetal growth restriction (37.5%), pregnancy-induced hypertension (37.5%), and preterm delivery (62.5%) in group C were higher than those (4.5%, 0%, and 4.5%, respectively) in group B (p<0.05). Women with RPL, PS deficiency, and positive aPL had high risks for adverse pregnancy outcome and complications, even when they received LDA/H therapy. Among women with RPL, PS, and negative aPL, there was no difference in these risks between LDA alone and LDA/H therapies.

Chinese abstract

本前瞻性研究的目的在于评估接受低剂量阿司匹林（LDA）或LDA加肝素（LDA/H）治疗的反复流产（recurrent pregnancy loss, RPL）与S蛋白（PS）缺乏的女性的妊娠结局与合并症。38例有过2次或2次以上RPL且血浆游离PS抗原<60%的患者的基本特征, 妊娠结局及合并症被分为三组进行对比: 接受LDA治疗的抗磷脂抗体（aPL）阴性的女性（A组）, 接受LDA/H治疗的aPL阴性的女性（B组）, 接受LDA/H治疗的aPL阳性的女性（C组）。C组的分娩孕周（gestational weeks, GW）（中位GW 32周）早于A组（40周）与B组（38.5周）女性（p < 0.05）。C组出生体重（中位1794g）低于B组（2855g, p < 0.05）。C组的胎儿生长受限（37.5%）、妊娠期高血压（37.5%）及早产（62.5%）的发生率高于B组（4.5%, 0%, 4.5%, p < 0.05）。合并RPL、PS缺乏症、aPL阳性的女性不良妊娠结局发生的风险更高, 即使她们接受了LDA/H治疗。在RPL、PS及aPL阴性的女性, LDA治疗组与LDA/H治疗组的风险没有差异。

• Heparin
• low-dose aspirin
• protein S deficiency
• recurrent pregnancy loss

Declaration of interest

The authors declare no conflicts of interest. This work was supported in part by a Grant-in-Aid from the Japan Society for the Promotion of Science (No. 26462489) and the Ministry of Health, Labor and Welfare of Japan (No. H25-Jisedai-Ippan-005).