Background Recurrent pregnancy loss is one of the major clinical features of antiphospholipid syndrome (APS). Although pregnancy losses in patients with antiphospholipid antibodies typically occur after the 10th week of gestation, early losses and premature birth also take place. Preliminary classification criteria for APS precisely define pregnancy morbidity associated with anticardiolipin antibodies (aCL) and/or with lupus anticoagulant (LA) as follows: 1) one or more unexplained fetal deaths; 2) one or more premature births; 3) three or more unexplained consecutive spontaneous abortions before the 10th week of gestation, when other causes (endocrine, genetic, and morphological) have been excluded.1
Objectives To assess the prevalence of elevated levels of anticardiolipin antibodies in otherwise healthy women with history of unexplained pregnancy losses and to investigate prevalence of APS among them.
Methods 29,8 ± 5,3
A cross-sectional study comprised fifty women (mean age 29,8 ± 5,3 years) with a history of unexplained pregnancy losses (median 3; range 1–6). None of these women had anatomical, endocrine, genetic or infective cause for miscarriage. Anticardiolipin antibodies of IgG and IgM isotype were measured by a standardised ELISA for beta2-GPI- dependent aCL.
Results 14 out of 50 (28%) women had elevated levels of aCL IgG (5) or IgM (6) or both (3) isotypes. Comparing aCL positive and aCL negative women, we found statistically significant difference in women age (32,3 ± 5,85 vs. 28,8 ± 4,8 years; p < 0,02) and fetal age at the time of miscarriage (median 18 vs. 10 weeks; p < 0,0001). Ten out of these 14 women fulfilled criteria for APS. During the follow-up of these patients that has lasted several years (3–5), 2 patients have developed full-blown of primary APS that includes thromboembolic events, and the other 3 were diagnosed as systemic lupus erythematosus (2) and overlap syndrome (1) with secondary APS.
Conclusion Elevated levels of anticardiolipin antibodies in women with unexplained pregnancy losses imply the presence of antiphospholipid syndrome. In fifty percent of these patients, full development of primary APS or secondary APS associated with systemic lupus erythematosus can be expected.
Wilson WA, Gharavi AE, Koike T, et al. International consensus statement on preliminary classification criteria for antiphospholipid syndrome: report of an international workshop. Artritis Rheum. 1999;42:1309–11
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