Promising Antibody Markers Identified for aPL-Related Pregnancy Complications

Antiphosphatidylserine/prothrombin (aPS/PT) antibodies may be promising antiphospholipid antibody (aPL)-related markers of pregnancy complications, particularly for intrauterine grown restriction (IUGR) and preeclampsia, and could help to identify patients who might require additional treatment, according to data published in The Journal of Rheumatology.

The investigators sought to explore the association between aPS/PT antibodies and pregnancy complications among patients with antiphospholipid syndrome (APS). A total of 55 women with APS who wanted to become pregnant were enrolled in the study and followed prospectively for 24 months. The researchers evaluated the presence of aPL antibodies, including anticardiolipin (aCL) antibodies, lupus-like anticoagulant (LLAC), anti-β₂-glycoprotein I (anti-β₂-GPI) antibodies, and aPS/PT antibodies.

Overall, 65% of patients with APS had aPS/PT antibodies. A total of 47 pregnancies were followed, including 33 women who were aPS/PT positive. Overall, 87% of the women who initiated a pregnancy gave birth to a child. Duration of the pregnancy and mean newborn weight at delivery were both significantly lower among patients who were aPS/PT positive compared with patients who were aPS/PT negative (33.1 ± 4.7 vs 36.2 ± 3.4 weeks of gestation, respectively; and 2058±964 g vs 2784±746 g, respectively; P <.05).

Late pregnancy complications, such as intrauterine fetal death, preterm delivery, IUGR, and preeclampsia were more common among women who were aPS/PT positive, regardless of therapy used. Titers of aPS/PT immunoglobulin antibodies were significantly inversely associated with neonatal weight at birth (P <.005). Among women who were aPS/PT positive, thrombosis, hemorrhage, and ischemic areas and features indicative of rather severe hypoxia such as chorangiomas were consistent features of placental samples.

Of the biomarkers associated with pregnancy complications, the simultaneous triple positivity of aCL, anti-β₂-GPI, and LLAC, which was reported in 36% of women, was significantly correlated with the occurrence of miscarriage after 10 weeks gestation or with intrauterine fetal death (P <.05). Moreover, the presence of aPS/PT might contribute further to the recognition of patients at higher risk for preeclampsia or IUGR.

The investigators concluded that the findings require verification in larger groups of patients. Additionally, the mechanisms by which aPS/PR antibodies interfere with pregnancy warrant further exploration.

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Reference

Canti V, Del Rosso S, Tonello M, et al. Antiphosphatidylserine/prothrombin antibodies in antiphospholipid syndrome with intrauterine growth restriction and preeclampsia [published online July 15, 2018]. J Rheumatol. doi: 10.3899/jrheum.170751