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Pregnancy and Clinical Outcome Among Women with Antiphospholipid Antibody Syndrome—A Tertiary Care Center–Based Observational Study

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Abstract

Antiphospholipid antibody syndrome (APS) is an acquired thrombophilia with multisystem involvement. This study was undertaken to study the antibody profile of pregnant women with APS and their pregnancy outcomes. This retrospective study was conducted in a tertiary care teaching institute in Southern India. Data of 231 APS-positive pregnancies in 104 women were analyzed in this study. The primary outcome was to study the adverse outcomes such as abortions, intrauterine fetal death, neonatal death, maternal thrombotic events, and preeclampsia in APS-complicated pregnancies. Secondary outcomes were to study the adverse clinical outcomes in comparison to various antiphospholipid antibodies; primary versus secondary APS; and obstetric versus thrombotic APS. Anticardiolipin antibody (ACLA) (n = 157, 68%) was the most common antibody identified followed by lupus anticoagulant (LA) (n = 80, 34.6%) and beta-2-glycoprotein (B2GP) (n = 48, 20.8%). B2GP positivity was associated with higher fetal growth restriction (FGR) (66.7% vs 36.3% vs 32.6%, p value 0.05) and stillbirth (30% vs 9.5% vs 13%, p 0.004) in comparison to ACLA and LA. Multiple antibody positivity was associated with a significantly higher first trimester losses (55.2% first trimester loss in double positive versus 43.2% in single antibody positive group; p 0.004). Thrombotic APS was associated with higher rates of intrauterine growth–restricted fetuses than obstetric APS (35.2% vs 55.9%, p 0.032). ACLA is the most common antibody identified in the APS-positive pregnancies in Southern Indian population. The adverse pregnancy outcomes were higher in multiple antibody positivity and B2GP group.

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Abbreviations

APS:

Antiphospholipid antibody syndrome

ACLA:

Anticardiolipin antibody

B2GP:

Beta-2-glycoprotein

LA:

Lupus anticoagulant

SLE:

Systemic lupus erythematosus

FGR:

Fetal growth retardation

IUFD:

Intrauterine fetal death

UFH:

Unfractionated heparin

LMWH:

Low molecular weight heparin

HCQ:

Hydroxychloroquine

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS) Madurai, Madurai, India

    Yavana Suriya Venkatesh

  2. Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India

    Murali Subbaiah

  3. Department of Clinical Immunology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India

    Chengappa Kavadichanda

  4. Department of Biostatistics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry, India

    Rajeswari Murugesan

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  1. Yavana Suriya Venkatesh
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  2. Murali Subbaiah
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  3. Chengappa Kavadichanda
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  4. Rajeswari Murugesan
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Contributions

Guarantor: YS.

Contributorship: YS, MS, and CKG conceived the idea and performed the search. YS and MS collected the records. RM performed the statistical analysis. YS, MS, and CKG wrote the draft. All authors contributed to revising and finalization of the manuscript.

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Correspondence to Yavana Suriya Venkatesh.

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The authors declare no competing interests.

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The study was approved by the Institute Ethics Committee (Human Studies) of Jawaharlal Institute of Postgraduate Medical Education and Research with the approval ID: JIP/IEC/2020/272.

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Venkatesh, Y.S., Subbaiah, M., Kavadichanda, C. et al. Pregnancy and Clinical Outcome Among Women with Antiphospholipid Antibody Syndrome—A Tertiary Care Center–Based Observational Study. SN Compr. Clin. Med. 6, 14 (2024). https://doi.org/10.1007/s42399-024-01643-z

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