Journal
JOURNAL OF THROMBOSIS AND HAEMOSTASIS
Volume 8, Issue 4, Pages 699-706Publisher
WILEY
DOI: 10.1111/j.1538-7836.2010.03747.x
Keywords
antiphospholipid antibodies; embryo; lupus anticoagulant; miscarriage; pregnancy
Categories
Funding
- Diagnostica Stago
- Baxter Healthcare Corporation
- Aventis pharmaceutical industry
- Clinical Research Committee of the University Hospital of Nimes
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Background: A clinical subtype of purely obstetrical antiphospholipid antibody (aPL-Ab) syndrome (APS) requires three or more unexplained consecutive embryonic losses before the 10th week of gestation associated with persistently positive lupus anticoagulant (LAC), and/or anticardiolipin IgG or IgM, and/or anti-beta 2-glycoprotein I (a beta 2GpI) IgG or IgM. Although this diagnostic classification of APS appeared to be the most sensitive, the APS-associated serological criteria are still debated. Patients/methods: We prospectively observed the second pregnancy of 284 women with a previous embryonic loss, both with and without aPL-Ab. Results: aPL-Ab-positive women were more prone to pregnancy loss, embryonic loss, pre-eclampsia, placental abruption and intrauterine fetal growth restriction. Type IIa aPL-Ab positivity (LAC present alone) was associated with the highest risk of recurrent embryonic loss and intrauterine growth restriction. Type I aPL-Ab positivity (combinations of aPL-Ab type positivity) was associated with the strongest risks of late complications, pre-eclampsia and placental abruption. Finally, a beta 2GpI-M positivities were not clinically relevant in these women. Conclusion: Patients with a first unexplained pregnancy loss before the 10th week of gestation who are also positive for aPL-Abs have a higher risk of various complications in their second pregnancy. In this study, measurement of a beta 2GpI-M had a questionable prognostic value.
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