Open AccessPrediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies
Author(s) -
Lockshin Michael D.,
Kim Mimi,
Laskin Carl A.,
Guerra Marta,
Branch D. Ware,
Merrill Joan,
Petri Michelle,
Porter T. Flint,
Sammaritano Lisa,
Stephenson Mary D.,
Buyon Jill,
Salmon Jane E.
Publication year - 2012
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/art.34402
Subject(s) - medicine , pregnancy , antiphospholipid syndrome , lupus anticoagulant , adverse effect , serology , prospective cohort study , obstetrics , multivariate analysis , systemic lupus erythematosus , immunology , antibody , thrombosis , disease , genetics , biology
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 β 2 ‐glycoprotein I [anti‐β 2 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‐β 2 GPI, and IgM anti‐β 2 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‐β 2 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‐β 2 GPI, if LAC is not also present, do not predict adverse pregnancy outcome.