Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica


IMPACT FACTOR 2017: 1.558
5-year IMPACT FACTOR: 1.653

CiteScore 2017: 1.26

SCImago Journal Rank (SJR) 2017: 0.594
Source Normalized Impact per Paper (SNIP) 2017: 0.684

Online
ISSN
1619-3997
See all formats and pricing
More options …
Volume 43, Issue 6

Issues

Neonatal outcome in pregnant patients with antiphospholipid syndrome

Katarina Jeremic
  • Corresponding author
  • Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Belgrade, Serbia
  • Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Aleksandar Stefanovic
  • Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Belgrade, Serbia
  • Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jelena Dotlic / Jelena Stojnic
  • Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Belgrade, Serbia
  • Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Sasa Kadija
  • Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia, Belgrade, Serbia
  • Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Zoran Vilendecic / Tijana Janjic / Jelena Jeremic
Published Online: 2014-10-16 | DOI: https://doi.org/10.1515/jpm-2014-0118

Abstract

Aims: The study aim was to evaluate pregnancy outcomes in patients with antiphospholipid syndrome (APS) and to determine which clinical parameters present risk factors for adverse pregnancy outcomes in these patients.

Methods: The study included 55 patients with APS treated at the Clinic for Ob/Gyn, Clinical Center of Serbia, from 2006 to 2012. The control group consisted of 55 healthy pregnant women. Data regarding previous pregnancies and conception method were registered. Immunological and laboratory tests were performed. Pregnancy outcomes, including miscarriage, intrauterine fetal death, hypertensive disorders, diabetes mellitus, phlebothrombosis, fetal growth restriction, premature delivery, delivery method, perinatal asphyxia, respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis were followed.

Results: The premature delivery rate in APS patients was 31.8%, and pregnancy loss was 18.2%. Significantly more patients with APS had thrombocytopenia, pregnancy losses, intrauterine growth restriction, and perinatal asphyxia compared with the control group. More miscarriages, preterm delivery, lower birth weight, preeclampsia, and IgM anticardiolipin antibody levels significantly correlated with adverse pregnancy outcomes. Although rare, respiratory distress syndrome can also worsen neonatal health status. According to ROC analysis, previous miscarriages correctly explained 66.3% of adverse pregnancy outcome cases. We generated four equations of adverse pregnancy outcome risk factors.

Conclusions: The most important prognostic factor for pregnancy outcome in APS patients is the number of previous miscarriages. Using appropriate current therapeutic protocol can enable live birth of a healthy newborn in most cases.

Keywords: Antiphospholipid syndrome; miscarriage; pregnancy; therapy

References

  • [1]

    Blank M, Shoenfeld Y. Antiphospholipid antibody-mediated reproductive failure in antiphospholipid syndrome. Clin Rev Allergy Immunol. 2010;38:141–7.CrossrefPubMedGoogle Scholar

  • [2]

    Bramham K, Hunt BJ, Germain S, Calatayud I, Khamashta MA, Bewely S, et al. Pregnancy outcome in different clinical phenotypes of antiphospholipid syndrome. Lupus. 2010;19:58–64.Web of SciencePubMedCrossrefGoogle Scholar

  • [3]

    Branch DW, Khamashta MA. Antiphospholipid syndrome: obstetric diagnosis, management and controversies. Obstet Gynecol. 2003;101:1333–44.PubMedCrossrefGoogle Scholar

  • [4]

    Cervera R, Piette JC, Font J, Khamasta MA, Shoenfeld Y, Camps MT, et al. Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1000 patients. Arthritis Rheum. 2002;46:1019–27.CrossrefGoogle Scholar

  • [5]

    Cervera R, Serrano R, Pons-Estel GJ, Ceberio-Hualde L, Shoenfeld Y, de Ramon E, et al. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis. 2013 doi:10.1136/annrheumdis-2013-204838.CrossrefGoogle Scholar

  • [6]

    Clark EAS, Silver RM, Branch W. Do Antiphospholipid antibodies cause preeclampsia and HELLP syndrome? Curr Rheumatol Rep. 2007;9:219–25.CrossrefPubMedGoogle Scholar

  • [7]

    Cohen D, Buurma A, Goemaere NN, Girardi G, le Cessie S, Scherjon S, et al. Classical complement activation as a footprint for murine and human antiphospholipid antibody-induced fetal loss. J Pathol. 2011;225:502–11.Web of ScienceGoogle Scholar

  • [8]

    Danza A, Ruiz-Iratostra G, Khamashta M. Antiphospholipid syndrome in obstetrics. Best Pract Res Clin Obstet Gynecol. 2012;26:65–76.CrossrefGoogle Scholar

  • [9]

    De Jesus GR, Rodrigues G, de Jesus NR, Levy RA. Pregnancy morbidity in antiphospholipid syndrome: what is the impact of treatment? Curr Rheumatol Rep. 2014;16:403.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [10]

    Di Prima FA, Valenti O, Hyseni E, Giorgio E, Faraci M, Renda E, et al. Antiphospholipid syndrome during pregnancy: the state of the art. J Prenat Med. 2011;5:41–53.PubMedGoogle Scholar

  • [11]

    Di Simone N, Castellani R, Raschi E, Borghi MO, Meroni PL, Caruso A. Anti-beta-2 glycoprotein I antibodies affect Bcl-2 and Bax trophoblast expression without evidence of apoptosis. Ann NY Acad Sci. 2006;1069:364–76.Google Scholar

  • [12]

    Empson M, Lassere M, Craig J, Scott J. Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst Rev. 2005;2:CD002859.Google Scholar

  • [13]

    Giannakopoulos B, Krilis SA. The Pathogenesis of the antiphospholipid syndrome. N Engl J Med. 2013;368:1033–44.Google Scholar

  • [14]

    Harper BE, Willis R, Pierangeli SS. Pathophysiologial mechanisms in antiphospholipid syndrome. J Clin Rheumatol. 2011;6:157–71.CrossrefGoogle Scholar

  • [15]

    Kutteh WH, Hinote CD. Antiphospholipid antibody syndrome. Obstet Gynecol Clin North Am. 2014;41:113–32.CrossrefPubMedGoogle Scholar

  • [16]

    Le Thi Thuong D, Tieulie N, Costedoat N, Andreu MR, Wechsler B, Vauthier-Brouzes D, et al. The HELLP syndrome in the antiphospholipid syndrome: retrospective study of 16 cases in 15 women. Ann Rheum Dis. 2005;64:273–8.CrossrefGoogle Scholar

  • [17]

    Mak IY, Brosens JJ, Christian M, Hills FA, Chamley L, Regan L, et al. Regulated expression of signal transducer and activator of transcription, Stat5, and its enhancement of PRL expression in human endometrial stromal cells in vitro. J Clin Endocrinol Metab. 2002;87:2581–8.CrossrefGoogle Scholar

  • [18]

    Marchetti T, Cohen M, de Moerloose P. Obstetrical antiphospholipid syndrome: from the pathogenesis to the clinical and therapeutic implications. Clin Dev Immunol. 2013;doi:10.1155/2013/159124.CrossrefWeb of ScienceGoogle Scholar

  • [19]

    Matsubayashi H, Sugi T, Arai T, Shida M, Kondo A, Suzuki T, et al. IgG-antiphospholipid antibodies in follicular fluid of IVF-ET patients are related to low fertilization rate of their oocytes. Am J Reprod Immunol. 2006;55:341–8.Web of SciencePubMedCrossrefGoogle Scholar

  • [20]

    Mulla MJ, Myrtolli K, Brosens JJ, Chamley LW, Kwak-Kim JY, Paidas MJ, et al. Antiphospholipid antibodies limit trophoblast migration by reducing IL-6 production and STAT3 activity. Am J Reprod Immunol. 2010;63:339–48.CrossrefWeb of ScienceGoogle Scholar

  • [21]

    Myakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295–308.CrossrefGoogle Scholar

  • [22]

    Nodler J, Moolamalla SR, Ledger EM, Nuwayhid BS, Mulla ZD. Elevated antiphospholipid antibody titres and adverse pregnancy outcomes: analysis of a population-based hospital dataset. BMC Pregnancy Childbirth. 2009;9:11.Web of ScienceCrossrefGoogle Scholar

  • [23]

    Qublan HS, Eid SS, Ababneh HA, Amarin ZO, Smadi AZ, Al-Khafaji FF, et al. Acquired and inherited thrombophilia: implication in recurrent IVF and embryo transfer failure. Hum Reprod. 2006;21:2694–8.CrossrefPubMedGoogle Scholar

  • [24]

    Sanmarco M, Bardin N, Camoin L, Beziane A, Dignat-George F, Gammere M, et al. Antigenic profile, prevalence, and clinical significance of antiphospholipid antibodies in women referred for in vitro fertilization. Ann NY Acad Sci. 2007;1108:457–65.Web of ScienceGoogle Scholar

  • [25]

    Serrano F, Nogueira I, Borges A, Branco J. Primary antiphospholipid syndrome: pregnancy outcome in a Portugese population. Acta Reumatol Port. 2009;34:492–97.Google Scholar

  • [26]

    Stone S, Hunt BJ, Khamashta MA, Bewely SJ, Nelson-Piercy C. Primary antiphospholipid syndrome in pregnancy: an analysis of outcome in a cohort of 33 women treated with a rigorous protocol. J Thromb Haemost. 2005;3:243–5.CrossrefGoogle Scholar

  • [27]

    Tincani A, Lojacono A, Taglietti M, Motta M, Biasini C, Decca L, et al. Pregnancy and neonatal outcome in antiphospholipid syndrome. Lupus. 2002;11:649.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [28]

    Van Horn JT, Craven C, Ward K, Branch DW, Silver RM. Histologic features of placentas and abortion specimens from women with antiphospholipid and antiphospholipid-like syndromes. Placenta. 2004;25:642–8.PubMedCrossrefGoogle Scholar

About the article

Corresponding author: Katarina Jeremic, Clinic of Obstetrics and Gynecology, Clinical Centre of Serbia; and Faculty of Medicine, University of Belgrade, Dr Koste Todorovica 26, Belgrade, Serbia, Tel.: +38 11 13 61 55 92, Fax: +38 11 13 61 56 03, E-mail:


Received: 2014-04-09

Accepted: 2014-09-15

Published Online: 2014-10-16

Published in Print: 2015-11-01


Citation Information: Journal of Perinatal Medicine, Volume 43, Issue 6, Pages 761–768, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2014-0118.

Export Citation

©2015 by De Gruyter.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
De Carolis Sara, Tabacco Sara, Rizzo Francesca, Giannini Andrea, Botta Angela, Salvi Silvia, Garufi Cristina, Benedetti Panici Pierluigi, and Lanzone Antonio
Autoimmunity Reviews, 2018
[2]
Maria Chiara Gerardi, Melissa Alexandre Fernandes, Angela Tincani, and Laura Andreoli
Current Rheumatology Reports, 2018, Volume 20, Number 10
[3]
Rinat Gabbay-Benziv, Hadas Zafrir-Danieli, Dorit Blickstein, Anat Shmueli, Lina Salman, and Eran Hadar
International Journal of Gynecology & Obstetrics, 2018
[4]
Ilaria Cavazzana, Laura Andreoli, Maarteen Limper, Franco Franceschini, and Angela Tincani
Current Rheumatology Reports, 2018, Volume 20, Number 3
[5]
L Andreoli, G K Bertsias, N Agmon-Levin, S Brown, R Cervera, N Costedoat-Chalumeau, A Doria, R Fischer-Betz, F Forger, M F Moraes-Fontes, M Khamashta, J King, A Lojacono, F Marchiori, P L Meroni, M Mosca, M Motta, M Ostensen, C Pamfil, L Raio, M Schneider, E Svenungsson, M Tektonidou, S Yavuz, D Boumpas, and A Tincani
Annals of the Rheumatic Diseases, 2017, Volume 76, Number 3, Page 476
[6]
J O Latino, S Udry, F M Aranda, S D A Perés Wingeyer, D S Fernández Romero, and G F de Larrañaga
Lupus, 2017, Page 096120331769243

Comments (0)

Please log in or register to comment.
Log in