A Multicenter Evaluation of Obstetric and Maternal Outcome in Prospectively Followed Pregnant Patients with Confirmed Positivity for Antiphospholipid Antibodies (aPL)

Micaela Fredi¹, Elena Aggogeri², Elisa Bettiga³, Laura Andreoli², Maria Grazia Lazzaroni², Véronique Le Guern⁴, Andrea Lojacono³, Fabrizio Lupoli², Nathalie Morel⁴, Jean Charles Piette⁵, Sonia Zatti³, Nathalie Costedoat-Chalumeau⁴ and Angela Tincani², ¹Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Brescia, Italy, ²Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, Brescia, Italy, ³Obstetrics and Gynecology, Spedali Civili and University of Brescia, Brescia, Italy, ⁴Internal Medicine Department, Cochin Hospital, “René-Descartes Paris V” University, Paris, France, ⁵Internal Medicine Department, University Hospital “Pitié-Salpêtrière”, “Pierre et Marie Curie Paris VI” University, Paris, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Antiphospholipid antibodies and pregnancy

Session Information

Date: Tuesday, November 10, 2015

Title: Reproductive Issues in Rheumatic Disorders: Basic and Clinical Aspects Poster Session

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:
Antiphospholipd antibodies (aPL) positivity is considered as a risk
factors for a poor obstetric outcome. The aim of this work was to
determine risk factors in patients (pts) with established aPL
positivity with/without a diagnosis of primary antiphospholipid
syndrome (PAPS) despite the administration of low dose aspirin (LDA)
and heparin (LMWH).

Methods:
Two
hundred
women were
prospectively followed in
the 3 Institutions involved between 2000 and 2014.
None of the pts had a concomitant systemic autoimmune disease, while
28 had an organ autoimmune disease. Data
were retrospectively collected from clinical charts using a common
database. Adverse
pregnancy outcome (APO) was considered the occurrence of pregnancy
loss, perinatal
deaths, preterm
deliveries before the 34 weeks due to preeclampsia and HELLP
syndrome.

Results: Among the 200 pts, 127 fulfilled the criteria
for PAPS and 73 did not. During the study pts had 283 pregnancies.
According to their clinical and biological characteristic we created
4 groups: 85 pts with obstetric (O-APS, 124 pregnancies), 42
thrombotic with/without obstetric (T-APS, 66 pregnancies), 39
incomplete clinical criteria (I-APS, 54 pregnancies) and 34 aPL
carriers without any clinical manifestation (39 pregnancies).

The mean age at the onset of
pregnancy was 32.4 years, the global rate of live births was 88%; APO
was observed in 50 cases (18%). In the table 1 are reported the
features statistically associated with APO at the univariate and
multivariate analysis. T-APS
was the group with the higher rate of APO (24%) followed by the aPL
carrier and O-APS (18%), few occurred among the I-APS (9%). In table
2 we reported APO divided for clinical group and features
statistically associated. We
collected 14 maternal complications: 7 thrombotic
events (3
DVT, 1 pulmonary embolism, 1 myocardial infarction, 2 CAPS) and
7 non-criteria manifestations (thrombocytopenia, hemolytic anemia,
epilepsy). The thrombotic events occurred mostly in T-APS pts (71%),
triple positive (53%) and during puerperium (53%).

Conclusion: A
non-negligible considerable rate of APO and other maternal
complications were observed even if the patients were treated
according the recommended guidelines confirming that these
pregnancies have to be considered at high risk for maternal and fetal
health. With this study we identified 3 profiles of patients with a
higher risk: thrombotic history, a more systemic APS phenotypes
(other APS manifestations, or complement reduction) and triple
positive aPL even without full criteria for APS.

Disclosure: M. Fredi, None; E. Aggogeri, None; E. Bettiga, None; L. Andreoli, None; M. G. Lazzaroni, None; V. Le Guern, None; A. Lojacono, None; F. Lupoli, None; N. Morel, None; J. C. Piette, None; S. Zatti, None; N. Costedoat-Chalumeau, None; A. Tincani, None.

To cite this abstract in AMA style:

Fredi M, Aggogeri E, Bettiga E, Andreoli L, Lazzaroni MG, Le Guern V, Lojacono A, Lupoli F, Morel N, Piette JC, Zatti S, Costedoat-Chalumeau N, Tincani A. A Multicenter Evaluation of Obstetric and Maternal Outcome in Prospectively Followed Pregnant Patients with Confirmed Positivity for Antiphospholipid Antibodies (aPL) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/a-multicenter-evaluation-of-obstetric-and-maternal-outcome-in-prospectively-followed-pregnant-patients-with-confirmed-positivity-for-antiphospholipid-antibodies-apl/. Accessed .

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