Document Detail


Prediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies.
MedLine Citation:
PMID:  22275304     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate which serologic and clinical findings predict adverse pregnancy outcome in patients with antiphospholipid antibody (aPL) and to test the hypothesis that a pattern of clinical and serologic variables can identify women at highest risk of adverse pregnancy outcome.
METHODS: Women enrolled in a multicenter prospective observational study of risk factors for adverse pregnancy outcome in patients with aPL (lupus anticoagulant [LAC], anticardiolipin antibody [aCL], and/or antibody to β2-glycoprotein I [anti-β2 GPI]) and/or systemic lupus erythematosus (SLE) were recruited for the present prospective study. Demographic, clinical, serologic, and treatment data were recorded at the time of the first study visit. The relationship between individual and combined variables and adverse pregnancy outcome was assessed by bivariate and multivariate analysis.
RESULTS: Between 2003 and 2011 we enrolled 144 pregnant patients, of whom 28 had adverse pregnancy outcome. Thirty-nine percent of the patients with LAC had adverse pregnancy outcome, compared to 3% of those who did not have LAC (P<0.0001). Among women with IgG aCL at a level of ≥40 units/ml, only 8% of those who were LAC negative had adverse pregnancy outcome, compared to 43% of those who were LAC positive (P=0.002). IgM aCL, IgG anti-β2 GPI, and IgM anti-β2 GPI did not predict adverse pregnancy outcome. In bivariate analysis, adverse pregnancy outcome occurred in 52% of patients with and 13% of patients without prior thrombosis (P=0.00005), and in 23% with SLE versus 17% without SLE (not significant); SLE was a predictor in multivariate analysis. Prior pregnancy loss did not predict adverse pregnancy outcome. Simultaneous positivity for aCL, anti-β2 GPI, and LAC did not predict adverse pregnancy outcome better than did positivity for LAC alone.
CONCLUSION: LAC is the primary predictor of adverse pregnancy outcome after 12 weeks' gestation in aPL-associated pregnancies. Anticardiolipin antibody and anti-β2 GPI, if LAC is not also present, do not predict adverse pregnancy outcome.
Authors:
Michael D Lockshin; Mimi Kim; Carl A Laskin; Marta Guerra; D Ware Branch; Joan Merrill; Michelle Petri; T Flint Porter; Lisa Sammaritano; Mary D Stephenson; Jill Buyon; Jane E Salmon
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  64     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-28     Completed Date:  2012-09-14     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2311-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 by the American College of Rheumatology.
Affiliation:
Hospital for Special Surgery and Weill Cornell Medical College, New York, New York. lockshinm@hss.edu.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antibodies, Anticardiolipin / blood*,  immunology
Antiphospholipid Syndrome / blood*,  immunology
Female
Humans
Lupus Coagulation Inhibitor / blood*,  immunology
Predictive Value of Tests
Pregnancy
Pregnancy Complications / blood*,  immunology
Pregnancy Outcome
Prospective Studies
Risk Factors
Grant Support
ID/Acronym/Agency:
R01 AR049772/AR/NIAMS NIH HHS; R01 AR049772-08/AR/NIAMS NIH HHS
Chemical
Reg. No./Substance:
0/Antibodies, Anticardiolipin; 0/Lupus Coagulation Inhibitor
Comments/Corrections

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