A Comparison of Obstetric Outcomes in Antiphospholipid Syndrome Among Pregnant Women With Systemic Lupus Erythematosus

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Jul 12

PMID 38993403

Authors

Dur E Shahwar

Duriya Rehmani

Amir Raza

Affiliations

Soon will be listed here.

Abstract

Objective The aim of this study was to evaluate the maternal and perinatal outcomes in systemic lupus erythematosus (SLE) women with antiphospholipid syndrome (APS). Methods This retrospective case-control study was conducted among pregnant women with SLE with and without APS. Group A included SLE patients with APS, whereas group B included pregnant SLE women without APS. Data were expressed as mean ± standard deviation (SD). Frequency and percentage were computed for categorical data. The chi-square test was used to analyze the difference between categorical data. Results Out of 125 cases of SLE, APS was found in 72 (57.6%) women. Almost 95.8% of patients were on treatment (aspirin and enoxaparin) in group A. Preterm delivery (31.89±7.36 versus 34.46±4.97; p=0.021) and termination of pregnancy (18.1% [13/72] versus 5.7% [3/53]; p=0.04) were statistically significant in group A. Among these terminations, second-trimester intrauterine death is found to be more in group A (SLE with APS) (16.7% [12/72]) as compared to group B (SLE without APS) (5.7% [3/53]) with a p-value of 0.05. Perinatal outcomes including NICU admissions (39% [23/59] versus 24% [12/50]; p=0.071) and neonatal death (12.3% [7/57]; p=0.015) were also found to be statistically significant between the two groups. Conclusion APS with SLE is associated with adverse pregnancy outcomes such as preterm birth, termination of pregnancy due to second-trimester fetal loss, more NICU admission, and neonatal deaths when compared to the control group. Hence, pregnancies with APS with SLE require vigilant monitoring and frequent follow-ups to ensure a positive pregnancy outcome.

References

Miyakis S, Lockshin M, Atsumi T, Branch D, Brey R, Cervera R . International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006; 4(2):295-306. DOI: 10.1111/j.1538-7836.2006.01753.x. View

Unlu O, Zuily S, Erkan D . The clinical significance of antiphospholipid antibodies in systemic lupus erythematosus. Eur J Rheumatol. 2016; 3(2):75-84. PMC: 5042235. DOI: 10.5152/eurjrheum.2015.0085. View

Buyon J, Kim M, Guerra M, Laskin C, Petri M, Lockshin M . Predictors of Pregnancy Outcomes in Patients With Lupus: A Cohort Study. Ann Intern Med. 2015; 163(3):153-63. PMC: 5113288. DOI: 10.7326/M14-2235. View

Clark C, Spitzer K, Laskin C . Decrease in pregnancy loss rates in patients with systemic lupus erythematosus over a 40-year period. J Rheumatol. 2005; 32(9):1709-12. View

Zeisler H, Llurba E, Chantraine F, Vatish M, Staff A, Sennstrom M . Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med. 2016; 374(1):13-22. DOI: 10.1056/NEJMoa1414838. View

Grygiel-Gorniak B, Mazurkiewicz L . Positive antiphospholipid antibodies: observation or treatment?. J Thromb Thrombolysis. 2023; 56(2):301-314. PMC: 10234248. DOI: 10.1007/s11239-023-02834-6. View

Singh G, Sidhu K . Bad Obstetric History: A Prospective Study. Med J Armed Forces India. 2016; 66(2):117-20. PMC: 4920907. DOI: 10.1016/S0377-1237(10)80121-2. View

Hamulyak E, Scheres L, Marijnen M, Goddijn M, Middeldorp S . Aspirin or heparin or both for improving pregnancy outcomes in women with persistent antiphospholipid antibodies and recurrent pregnancy loss. Cochrane Database Syst Rev. 2020; 5:CD012852. PMC: 7195627. DOI: 10.1002/14651858.CD012852.pub2. View

Schreiber K, Hunt B . Managing antiphospholipid syndrome in pregnancy. Thromb Res. 2019; 181 Suppl 1:S41-S46. DOI: 10.1016/S0049-3848(19)30366-4. View

10.

Abou-Nassar K, Carrier M, Ramsay T, Rodger M . The association between antiphospholipid antibodies and placenta mediated complications: a systematic review and meta-analysis. Thromb Res. 2011; 128(1):77-85. DOI: 10.1016/j.thromres.2011.02.006. View

11.

Erton Z, Sevim E, Ramires de Jesus G, Cervera R, Ji L, Pengo V . Pregnancy outcomes in antiphospholipid antibody positive patients: prospective results from the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ('Registry'). Lupus Sci Med. 2022; 9(1). PMC: 9198709. DOI: 10.1136/lupus-2021-000633. View

12.

Ritchie J, Smyth A, Tower C, Helbert M, Venning M, Garovic V . Maternal deaths in women with lupus nephritis: a review of published evidence. Lupus. 2012; 21(5):534-41. DOI: 10.1177/0961203311434939. View

13.

Dabit J, Valenzuela-Almada M, Vallejo-Ramos S, Duarte-Garcia A . Epidemiology of Antiphospholipid Syndrome in the General Population. Curr Rheumatol Rep. 2022; 23(12):85. PMC: 8727975. DOI: 10.1007/s11926-021-01038-2. View

14.

do Prado A, Piovesan D, Staub H, Horta B . Association of anticardiolipin antibodies with preeclampsia: a systematic review and meta-analysis. Obstet Gynecol. 2010; 116(6):1433-1443. DOI: 10.1097/AOG.0b013e3181fe02ec. View

15.

Yamada H, Atsumi T, Kobashi G, Ota C, Kato E, Tsuruga N . Antiphospholipid antibodies increase the risk of pregnancy-induced hypertension and adverse pregnancy outcomes. J Reprod Immunol. 2009; 79(2):188-95. DOI: 10.1016/j.jri.2008.11.001. View

16.

Clowse M, Magder L, Witter F, Petri M . Early risk factors for pregnancy loss in lupus. Obstet Gynecol. 2006; 107(2 Pt 1):293-9. DOI: 10.1097/01.AOG.0000194205.95870.86. View

17.

Yelnik C, Laskin C, Porter T, Branch D, Buyon J, Guerra M . Lupus anticoagulant is the main predictor of adverse pregnancy outcomes in aPL-positive patients: validation of PROMISSE study results. Lupus Sci Med. 2016; 3(1):e000131. PMC: 4716418. DOI: 10.1136/lupus-2015-000131. View

18.

Hochberg M . Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997; 40(9):1725. DOI: 10.1002/art.1780400928. View

19.

Tektonidou M, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N . EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis. 2019; 78(10):1296-1304. PMC: 11034817. DOI: 10.1136/annrheumdis-2019-215213. View

20.

Capecchi M, Abbattista M, Ciavarella A, Uhr M, Novembrino C, Martinelli I . Anticoagulant Therapy in Patients with Antiphospholipid Syndrome. J Clin Med. 2022; 11(23). PMC: 9741036. DOI: 10.3390/jcm11236984. View