CLINICAL HAEMOSTASIS AND THROMBOSIS
Observational study of pregnant women with a previous spontaneous abortion before the 10th gestation week with and without antiphospholipid antibodies

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Summary

Background: A clinical subtype of purely obstetrical antiphospholipid antibody (aPL‐Ab) syndrome (APS) requires three or more unexplained consecutive embryonic losses before the 10th week of gestation associated with persistently positive lupus anticoagulant (LAC), and/or anticardiolipin IgG or IgM, and/or anti‐β2‐glycoprotein I (aβ2GpI) IgG or IgM. Although this diagnostic classification of APS appeared to be the most sensitive, the APS‐associated serological criteria are still debated. Patients/methods: We prospectively observed the second pregnancy of 284 women with a previous embryonic loss, both with and without aPL‐Ab. Results: aPL‐Ab‐positive women were more prone to pregnancy loss, embryonic loss, pre‐eclampsia, placental abruption and intrauterine fetal growth restriction. Type IIa aPL‐Ab positivity (LAC present alone) was associated with the highest risk of recurrent embryonic loss and intrauterine growth restriction. Type I aPL‐Ab positivity (combinations of aPL‐Ab type positivity) was associated with the strongest risks of late complications, pre‐eclampsia and placental abruption. Finally, aβ2GpI‐M positivities were not clinically relevant in these women. Conclusion: Patients with a first unexplained pregnancy loss before the 10th week of gestation who are also positive for aPL‐Abs have a higher risk of various complications in their second pregnancy. In this study, measurement of aβ2GpI‐M had a questionable prognostic value.

Keywords

antiphospholipid antibodies
embryo
lupus anticoagulant
miscarriage
pregnancy

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These four authors contributed equally to the work.