What is the best time to assess the antiphospholipid antibodies (aPL) profile to better predict the obstetric outcome in
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ORIGINAL ARTICLE
What is the best time to assess the antiphospholipid antibodies (aPL) profile to better predict the obstetric outcome in antiphospholipid syndrome (APS) patients? Jose Omar Latino 1 & Sebastián Udry 1,2 & Silvia Perés Wingeyer 2 & Diego Fernández Romero 1 & Paula Micone 1 & Gabriela de Larrañaga 2
# Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Serological risk factors are the most important determinant in predicting unsuccessful pregnancy in obstetric antiphospholipid antibodies syndrome (OAPS) despite conventional treatment. It is not clear if changes in the profile of antiphospholipid antibodies (aPL) during pregnancy modify the risk associated with a poor response to conventional treatment. The aim of our study was to compare the value of a serological tag for aPL obtained before and during the first trimester of pregnancy to predict the response to conventional treatment. We carefully selected 97 pregnancies in women who were included in our study only if they were diagnosed with OAPS prior to a new pregnancy (basal serological risk), retested for aPL during the first trimester of pregnancy (serological risk during pregnancy), and treated with conventional therapy. High baseline serological risk was associated with pregnancy failure in 62.1% of cases (18/29) and predicted 82.5% of pregnancy outcomes with conventional treatment: OR = 16.9, CI = 5.5–52.1, p < 0.001. High serological risk during pregnancy was associated with pregnancy failure in 86.3% of cases (19/22) and predicted 91.8% of pregnancy outcomes with conventional treatment: OR = 88.7, CI = 19.4–404.8, p < 0.001. According to these results, we found that risk categorization performed during pregnancy was better in predicting pregnancy outcome (82.5 vs. 91.8%). Moreover, risk categorization during pregnancy had an increased specificity regarding the prediction: 84.9% at baseline and 95.9% during pregnancy (p = 0.024). Our findings suggest that it is important to perform aPL during the first trimester of pregnancy since that is the best time to establish the serological risk factors. Keywords Obstetric antiphospholipid syndrome . High risk . Pregnancy . Pregnancy failure . Triple positivity
Introduction Obstetric antiphospholipid syndrome (OAPS) is an autoimmune disease characterized by the presence of antiphospholipid antibodies (aPL) associated with pregnancy complications [1]. The outcomes of pregnancies in these patients treated with heparin and aspirin have dramatically Jose Omar Latino and Sebastián Udry contributed equally to this work. * Gabriela de Larrañaga [email protected] 1
Autoimmune, Thrombophilic Diseases and Pregnancy Section, Acute Hospital BDr. Carlos G. Durand^, Av. Díaz Vélez 5044, C1405AEN City of Buenos Aires, Argentina
2
Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases BDr. Francisco J. Muñiz^, Uspallata 2272, C1282AEN City of Buenos Aires, Argentina
improved in recent years (75% result in the birth of a healthy newborn) [2–5]. Despite this progress,
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