ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 6

Researchers’ Own Experience In Managing Obstetric Complications In Pregnant Women With Antiphospholipid Syndrome

Lidia Ostanek1, Danuta Bobrowska - Snarska2, Barbara Nestorowicz3 and Marek Brzosko4, 1Department of Rheumatology and Internal Diseases, Pomeranian Medical University, Szczecin, Poland, Szczecin, Poland, 2Department of Rheumatology, Pomeranian Medical University, Szczecin, Poland, Szczecin, Poland, 3Department of Pathological Obstetrics and Delivery, Pomeranian Medical University , Szczecin, Poland, Szczecin, Poland, 4Department of Rheumatology and Internal Diseases, Department of Rheumatology and Internal Diseases Pomeranian Medical University in Szczecin, Szczecin, Poland

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Antiphospholipid Syndrome: Clinical Manifestations and New Biomarkers in Antiphospholipid Syndrome

Session Type: Abstract Submissions (ACR)

Background/Purpose:

  1. To analyse risk factors for obstetric pathology in patients with antiphospholipid syndrome (APS).
  2. To assess the effectiveness of treatment depending on pharmacotherapy.  

Methods:

The courses of 275 pregnancies and deliveries in patients with diagnosed APS (PAPS-68, SAPS-41 patients) were analysed. 101 pregnancies were treated according to current recommendations. The treatment was consistently followed up with both a rheumatologist and an obstetrician. A retrospective analysis of previous pregnancies and deliveries, both treated and untreated was conducted. The immunological profile of the patients (ANA, SS-A, SS-B, Ro52, lupus anticoagulant (LA), anticardiolipin antibodies (aCL), anti β2GPI (aβ2GPI), antiprothrombin antibodies (aPTR), anti-phosphatidylserine (aPS), complement component 3 and complement component 4) was investigated. Assessment of metabolic and environmental factors influencing pregnancy (smoking, arterial hypertension, lipid profile, hyperglycaemia, uric acid concentration) was carried out. Yate’s chi-sqared test, Pearson’s ch-sqared test, Spearman’s rank correlation and logistic regression analysis were used to conduct the statistical analysis.   

Results:

Risk factors for unsuccessful pregnancy included: young age at the diagnosis and during pregnancy (p<0,001), presence of LA (p=0,0046), aPTR (p=0,034), arterial hypertension (p=0,012), hyperuricemia (p=0,005). Miscarriages were more frequent in patients with PAPS than with SAPS (p=0,007), in patients with aCL IgM (p=0,042) and in patients treated with glucocorticosteroid (GS) (p=0,027). Premature births were more frequent in young patients (p=0,002), with SAPS (p=0,005), with presence of ANA (p=0,0026), LA (p=0,045), low concentration of C3 (p=0,006), patients with smoking history (p=0,018) and those treated with GS (p=0,000). The presence of LA involved the risk of fetal death (p=0,027). Chances of successful pregnancy were enhanced by: the application of low molecular weight heparin (LMWH)(p=0,000),aspirin (ASA) (p=0,001), combined treatment: LMWH+ASA (p=0,002), and immunoglobulins iv (p=0,002).  

Conclusion:

1.The occurrence of aPL and diagnosis of APS increase the risk of obstetric pathology.

2. Apart from immunologic factors (aCL, LA, aPTR,↓C3), there are other factors which determine the risk of pregnancy failure, i.e. demographic factors (age), environmental factors (smoking, hyperuricemia) and associated treatment (GS).

3. PAPS increases the risk of miscarriage, SAPS increases the risk of premature birth.

4. Treating APS patients with ASA, LMWH, and in justified cases with immunoglobulins iv, increases the chances of successful pregnancy.

Disclosure:

L. Ostanek,
None;

D. Bobrowska – Snarska,
None;

B. Nestorowicz,
None;

M. Brzosko,
None.

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