Risks of reproductive loss and placenta-mediated pregnancy complications in women with antiphospholipid antibodies
Abstract
Introduction. Antiphospholipid syndrome (AРS) is a multisystem disease characterized by elevated levels of antiphospholipid antibodies (AРA), arterial and/or venous thrombosis, thrombocytopenia, and habitual miscarriage. Various AРA types have multifactorial and indirect effects on pregnancy course from the earliest stages, leading to termination of pregnancy and putting the prerequisites for further obstetric complications.
Aim: determine rate and relative risk of pregnancy complications in AРA carriers.
Materials and Methods. The retrospective study, conducted between 2017 and 2019, included 268 pregnant women. All women underwent a comprehensive study consisting of clinical examination and laboratory methods. AРA of IgM and IgG classes were measured by using ELISA, lupus anticoagulant (LA) was estimated by using a coagulometer.
Results. APA were detected in 213 (79.48 %) women examined; 55 (20.52 %) patients (n = 55) lacked APA. Failed in vitro fertilization attempts were 2 times more common in women with AРA (10.33 vs. 5.45 %, respectively; p < 0.001). Also, significant differences were found in this group in antenatal fetal death (4.23 vs. 1.82 %, respectively; p < 0.001) and chronic placental insufficiency without fetal malnutrition (23.47 vs. 18.18 %, respectively; p < 0.05). Of 165 women with early pregnancy loss syndrome, AРA were found in 130 (78.79 %), late pregnancy loss – in 29 (76.32 %) and antenatal fetal death – in 9 (90.0 %) women carrying serum AРA. The relative risks of unfavorable pregnancy outcomes have been identified for various AРA subtypes.
Conclusion. Identifying clear-cut relative risks of adverse pregnancy outcomes for various subtypes of antiphospholipid antibodies will allow to determine risk groups and develop a special treatment algorithm for preventing pregnancy complications and perinatal losses.
About the Authors
Yu. S. Dolgova
Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation;
Snegirev Maternity Hospital № 6
Russian Federation
Russian Federation
Yulia S. Dolgova – MD, Senior Assistant, Department of Obstetrics, Gynecology and Reproductive Medicine
6/8 Lev Tolstoy Str., Saint Petersburg 197022;
Obstetrician-Gynecologist, Obstetric Department of Pregnancy Pathology
5 Mayakovskogo Str., Saint Petersburg 192014
D. R. Eremeeva
Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation;
Snegirev Maternity Hospital № 6
Russian Federation
Russian Federation
Dina R. Eremeeva – MD, PhD, Assistant, Department of Obstetrics, Gynecology and Reproductive Medicine
6/8 Lev Tolstoy Str., Saint Petersburg 197022;
Deputy of Head Physician
5 Mayakovskogo Str., Saint Petersburg 192014
M. S. Zainulina
Pavlov First Saint Petersburg State Medical University, Health Ministry of Russian Federation;
Snegirev Maternity Hospital № 6
Russian Federation
Russian Federation
Marina S. Zainulina – MD, Dr Sci Med, Professor, Department of Obstetrics, Gynecology and Reproductive Medicine;
Head Physician;
Scopus Author ID: 37076359000. Researcher ID: B-5746-2018
6/8 Lev Tolstoy Str., Saint Petersburg 197022;
5 Mayakovskogo Str., Saint Petersburg 192014
References
1. Pengo V., Denas G., Padayattil S. et al. Diagnosis and therapy of antiphospholipid syndrome. Pol Arch Med Wewn. 2015;125(9):672–7. https://doi.org/10.20452/pamw.3051.
2. Hughes G.R. Thrombosis, abortion, cerebral disease, and the lupus anticoagulant. Br Med J (Clin Res Ed). 1983;287(6399):1088–9. https://doi.org/10.1136/bmj.287.6399.1088.
3. Bargakan Z.S., Momot A.P., Tsyvkina L.P. et al. The principles of laboratory diagnosis of "antiphospholipid syndrome". [Osnovy laboratornoj diagnostiki "antifosfolipidnogo sindroma"]. Tromboz, gemostaz i reologiya. 2000;(3):13–6. (In Russ.).
4. Chapaeva N.N., Trifonova M.A. The role of family anamnesis investigation in antiphospholipid syndrome. [Znachenie issledovaniya semejnogo anamneza pri antifosfolipidnom syndrome]. Byulleten' sibirskoj mediciny. 2009;8(2):61–8. (In Russ.).
5. Makatsariya A.D., Bitsadze V.O., Khizroeva D.Kh. et al. Pathogenetic significance of antiphospholipid antibodies. [Patogeneticheskoe znachenie antifosfolipidnyh antitel]. Prakticheskaya medicina. 2012;(5):9–21. (In Russ.).
6. Matveeva E.S. Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. [Techenie beremennosti pri sistemnoj krasnoj volchanke s antifosfolipidnym sindromom]. Byulleten' medicinskih internet-konferencij. 2013;3(2):126. (In Russ.).
7. Navarro-Carpentieri D., Del Carmen Castillo-Hernandez M., Majluf-Cruz K. et al. Impact of classical risk factors for arterial or venous thrombosis in patients with antiphospholipid syndrome. Clin Appl Thromb Hemost. 2018;24(5):834–40. https://doi.org/10.1177/1076029617727859.
8. Andreoli L., Bertsias G.K., Agmon-Levin N. et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017;76(3):476–85. https://doi.org/10.1136/annrheumdis-2016-209770.
9. Keragala C.B., Draxler D.F., Mc Quilten K.Z., Medcalf R.L. Haemostasis and innate immunity – a complementary relationship: A review of the intricate relationship between coagulation and complement pathways. Br J Haematol. 2018;180(6):782–98. https://doi.org/10.1111/bjh.15062.
10. da Silva Santos T., Ieque A.L., de Carvalho H.C. et al. Antiphospholipid syndrome and recurrent miscarriage: A systematic review and metaanalysis. J Reprod Immunol. 2017;123:78–87. http://dx.doi.org/10.1016/j.jri.2017.09.007.
11. Kaneko K., Mishima S., Goto M. et al. Clinical feature and antiphospholipid antibody profiles of pregnancy failure in young women with antiphospholipid antibody syndrome treated with conventional therapy. Mod Rheumatol. 2018;28(4):670–5. https://doi.org/10.1080/14397595.2017.1386845.
12. Selkhadzhieva M.S. The role of circulating antiphospholipid antibodies in the fetal loss syndrome development. [Rol' cirkuliruyushchih antifosfolipidnyh antitel v razvitii sindroma poteri ploda]. Akusherstvo, Ginekologia i Reprodukcia. 2014;8(1):31–3. (In Russ.).
13. Sater M.S., Finan R.R., Abu-Hijleh F.M. et al. Anti-phosphatidylserine, anti-cardiolipin, anti-β2-glycoprotein I and anti-prothrombin antibodies in recurrent miscarriage at 8–12 gestational weeks. Eur J Obstet Gynecol Reprod Biol. 2012;163(2):170–4. https://doi.org/10.1016/j.ejogrb.2012.04.001.
14. Motak-Pochrzest H., Malinowski А. Does autoimmunity play a role in the risk of implantation failures? Neuro Endocrinol Lett. 2018;38(8):575–8.
15. Fischer-Betz R., Specker C., Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. Best Pract Res Clin Rheumatol. 2017;31(3):397–414. https://doi.org/10.1016/j.berh.2017.09.011.
16. Schreiber K., Hunt B. J. Pregnancy and antiphospholipid syndrome. Semin Thromb Hemost. 2016;42(7):780–8. https://doi.org/10.1055/s-0036-1592336.
17. Islama M. A. et al. Genetic risk factors in thrombotic primary antiphospholipid syndrome: A systematic review with bioinformatic analyses. Autoimmun Rev. 2018;17(3):226–43. https://doi.org/10.1016/j.autrev.2017.10.014.
18. Chepanov S.V., Shlyakhtenko T.N., Zainulina M.S. et al. Anti-annexin V antibodies in women with recurrent miscarriage. [Antitela k anneksinu V u zhenshchin s privychnym nevynashivaniem beremennosti]. Akusherstvo i ginekologiya. 2014;(7):29–32. (In Russ.).
19. Menzhinskaya I.V., Kashentseva M.M., Ionanidze T.B. et al. Range of antiphospholipid antibodies in women with recurrent miscarriage and their diagnostic value. [Spektr antifosfolipidnyh antitel u zhenshchin s privychnym nevynashivaniem beremennosti i ih diagnosticheskoe znachenie]. Immunologiya. 2016;37(1):4–9. https://doi.org/10.18821/0206-4952-2016-37-1-4-9. (In Russ.).
For citation:
Dolgova Yu.S., Eremeeva D.R., Zainulina M.S. Risks of reproductive loss and placenta-mediated pregnancy complications in women with antiphospholipid antibodies. Obstetrics, Gynecology and Reproduction. 2020;14(6):592-601. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.181
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