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')

Hospital for Special Surgery. Divison of Rheumatology. New York, NY, USA
Yeshiva University. Albert Einstein College of Medicine. Bronx, NY, USA / Montefiore Medical Center. Internal Medicine. Bronx, NY, USA.
Universidade do Estado do Rio de Janeiro. Centro Biomédico. Faculdade de Ciências Médicas. Departamento de Ginecologia e Obstetrícia. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil.
Institut Clínic de Medicina i Dermatologia. Hospital Clínic de Barcelona. Autoimmune Diseases. Barcelona, Spain.
Peking University First Hospital. Department of Rheumatology and Clinical Immunology. Beijing, Beijing, China.
University of Padova. Cardiac Thoracic and Vascular Sciences. Padua, Italy.
Hospital de Cruces. Internal Medicine. Barkaldo, Spain.
Universidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil.
University of Brescia. Department of Clinical and Experimental Sciences. Brescia, Italy / ASST Spedali Civili di Brescia. Unit of Rheumatology and Clinical Immunology. Brescia, Italy.
Hokkaido University. School of Medicine. Medicine II. Sapporo, Japan.
Centre Hospitalier de l’Université Laval. Medicine - Rheumatology. Quebec City, Quebec, Canada.
University of Milano. Division of Rheumatology. Dept. of Clinical & Community Science. Milano, Italy.
University of Michigan. Internal Medicine/Division of Rheumatology. Ann Arbor, Michigan, USA.
Johns Hopkins University. Rheumatology. Baltimore, Maryland, USA.
Università di Torino. Ospedale Torino Nord Emergenza San G. Bosco. Struttura Complessa a Direzione Universitaria di Immunologia Clinica. Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare. Dipartimento di Malattie Rare, Immunologiche, Ematologiche ed Immunoematologiche. Torino, Italy.
National and Kapodistrian University of Athens. First Department of Propaedeutic Internal Medicine. Athens, Greece.
University Hospital “Reina Sofia”. Rheumatology. Cordoba, Spain.
University of Utah. Health Sciences Center. Maternal-Fetal Medicine. Salt Lake City, Utah, USA / Intermountain Healthcare. Maternal-Fetal Medicine. Salt Lake City, Utah, USA.
Weill Cornell Medicine. Hospital for Special Surgery. Barbara Volcker Center for Women and Rheumatic Diseases. Rheumatology. New York, NY, USA.

Abstract

Objectives: To describe the outcomes of pregnancies in antiphospholipid antibody (aPL)-positive patients since the inception of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Registry. Methods: We identified persistently aPL-positive patients recorded as ‘pregnant’ during prospective follow-up, and defined ‘aPL-related outcome’ as a composite of: (1) Preterm live delivery (PTLD) at or before 37th week due to pre-eclampsia (PEC), eclampsia, small-for-gestational age (SGA) and/or placental insufficiency (PI); or (2) Otherwise unexplained fetal death after the 10th week of gestation. The primary objective was to describe the characteristics of patients with and without aPL-related composite outcomes based on their first observed pregnancies following registry recruitment. Results: Of the 55 first pregnancies observed after registry recruitment among nulliparous and multiparous participants, 15 (27%) resulted in early pregnancy loss <10 weeks gestation. Of the remaining 40 pregnancies: (1) 26 (65%) resulted in term live delivery (TLD), 4 (10%) in PTLD between 34.0 weeks and 36.6 weeks, 5 (12.5%) in PTLD before 34th week, and 5 (12.5%) in fetal death (two associated with genetic anomalies); and (2) The aPL-related composite outcome occurred in 9 (23%). One of 26 (4%) pregnancies with TLD, 3/4 (75%) with PTLD between 34.0 weeks and 36.6 weeks, and 3/5 (60%) with PTLD before 34th week were complicated with PEC, SGA and/or PI. Fifty of 55 (91%) pregnancies were in lupus anticoagulant positive subjects, as well as all pregnancies with aPL-related composite outcome. Conclusion: In our multicentre, international, aPL-positive cohort, of 55 first pregnancies observed prospectively, 15 (27%) were complicated by early pregnancy loss. Of the remaining 40 pregnancies, composite pregnancy morbidity was observed in 9 (23%) pregnancies.

Keywords

AntiPhospholipid Syndrome
APS ACTION
Fetal death
Pregnancy loss
Demographics features
Clinical features

Publisher

BMJ Publishing Group

Citation

ERTON, Zeynep Belce et al. 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 Science & Medicine, v. 9, n. e000633, p. 1-10, 14 June 2022.

DOI

10.1136/lupus-2021-000633

ISSN

2053-8790

Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/55069

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Open access

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