Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A Multicenter Study on 62 Pregnancies
Objective: Antiphospholipid antibodies (aPL) are risk factors for thrombosis and adverse pregnancy outcomes (APO). The management of the so called “aPL carriers” (subjects with aPL positivity without the clinical criteria manifestations of APS) is still undefined. This study aims at retrospectively...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-08-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fimmu.2019.01948/full |
| _version_ | 1819160913030152192 |
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| author | Maria-Grazia Lazzaroni Maria-Grazia Lazzaroni Micaela Fredi Micaela Fredi Laura Andreoli Laura Andreoli Cecilia Beatrice Chighizola Cecilia Beatrice Chighizola Teresa Del Ross Maria Gerosa Maria Gerosa Anna Kuzenko Maria-Gabriella Raimondo Maria-Gabriella Raimondo Andrea Lojacono Andrea Lojacono Francesca Ramazzotto Sonia Zatti Laura Trespidi Pier-Luigi Meroni Vittorio Pengo Amelia Ruffatti Angela Tincani Angela Tincani Angela Tincani |
| author_facet | Maria-Grazia Lazzaroni Maria-Grazia Lazzaroni Micaela Fredi Micaela Fredi Laura Andreoli Laura Andreoli Cecilia Beatrice Chighizola Cecilia Beatrice Chighizola Teresa Del Ross Maria Gerosa Maria Gerosa Anna Kuzenko Maria-Gabriella Raimondo Maria-Gabriella Raimondo Andrea Lojacono Andrea Lojacono Francesca Ramazzotto Sonia Zatti Laura Trespidi Pier-Luigi Meroni Vittorio Pengo Amelia Ruffatti Angela Tincani Angela Tincani Angela Tincani |
| author_sort | Maria-Grazia Lazzaroni |
| collection | DOAJ |
| description | Objective: Antiphospholipid antibodies (aPL) are risk factors for thrombosis and adverse pregnancy outcomes (APO). The management of the so called “aPL carriers” (subjects with aPL positivity without the clinical criteria manifestations of APS) is still undefined. This study aims at retrospectively evaluating the outcomes and the factors associated with APO and maternal complications in 62 pregnant aPL carriers.Methods: Medical records of pregnant women regularly attending the Pregnancy Clinic of 3 Rheumatology centers from January 1994 to December 2015 were retrospectively evaluated. Patients with concomitant autoimmune diseases or other causes of pregnancy complications were excluded.Results: An aPL-related event was recorded in 8 out of 62 patients (12.9%) during pregnancy: 2 thrombosis and 6 APO. At univariate analysis, factors associated with pregnancy complications were acquired risk factors (p:0.008), non-criteria aPL manifestations (p:0.024), lupus-like manifestations (p:0.013), and triple positive aPL profile (p:0.001). At multivariate analysis, only the association with a triple aPL profile was confirmed (p:0.01, OR 21.3, CI 95% 1.84–247). Patients with triple aPL positivity had a higher rate of pregnancy complications, despite they were more frequently receiving combined treatment of low dose aspirin (LDA) and low molecular weight heparin (LMWH) at prophylactic dose.Conclusion: This study highlights the importance of risk stratification in pregnant aPL carriers, in terms of both immunologic and non-immunologic features. Combination treatment with LDA and LMWH did not prevent APO in some cases, especially in carriers of triple aPL positivity. Triple positive aPL carriers may deserve additional therapeutic strategies during pregnancy. |
| first_indexed | 2024-12-22T17:04:00Z |
| format | Article |
| id | doaj.art-9eb9ace6e6094bad812b260b2082f1d7 |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-12-22T17:04:00Z |
| publishDate | 2019-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-9eb9ace6e6094bad812b260b2082f1d72022-12-21T18:19:16ZengFrontiers Media S.A.Frontiers in Immunology1664-32242019-08-011010.3389/fimmu.2019.01948476579Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A Multicenter Study on 62 PregnanciesMaria-Grazia Lazzaroni0Maria-Grazia Lazzaroni1Micaela Fredi2Micaela Fredi3Laura Andreoli4Laura Andreoli5Cecilia Beatrice Chighizola6Cecilia Beatrice Chighizola7Teresa Del Ross8Maria Gerosa9Maria Gerosa10Anna Kuzenko11Maria-Gabriella Raimondo12Maria-Gabriella Raimondo13Andrea Lojacono14Andrea Lojacono15Francesca Ramazzotto16Sonia Zatti17Laura Trespidi18Pier-Luigi Meroni19Vittorio Pengo20Amelia Ruffatti21Angela Tincani22Angela Tincani23Angela Tincani24Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, ItalyImmunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, ItalyRheumatology Unit, Istituto Auxologico Italiano, Milan, ItalyRheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, ItalyDivision of Clinical Rheumatology, ASST Pini-CTO, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyRheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, ItalyDivision of Clinical Rheumatology, ASST Pini-CTO, Milan, ItalyDepartment of Clinical Sciences and Community Health, University of Milan, Milan, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyObstetrics and Gynaecology Unit, ASST Spedali Civili, Brescia, ItalyObstetrics and Gynaecology Unit, ASST Spedali Civili, Brescia, ItalyObstetrics and Gynaecology Unit, ASST Spedali Civili, Brescia, ItalyObstetrics and Gynaecology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, ItalyImmunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milan, Italy0Cardiology Clinic, Department of Cardiac Thoracic and Vascular Sciences, Thrombosis Centre, University of Padova, Padova, ItalyRheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, ItalyDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyRheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy1I.M. Sechenov First Moscow State Medical University, Moscow, RussiaObjective: Antiphospholipid antibodies (aPL) are risk factors for thrombosis and adverse pregnancy outcomes (APO). The management of the so called “aPL carriers” (subjects with aPL positivity without the clinical criteria manifestations of APS) is still undefined. This study aims at retrospectively evaluating the outcomes and the factors associated with APO and maternal complications in 62 pregnant aPL carriers.Methods: Medical records of pregnant women regularly attending the Pregnancy Clinic of 3 Rheumatology centers from January 1994 to December 2015 were retrospectively evaluated. Patients with concomitant autoimmune diseases or other causes of pregnancy complications were excluded.Results: An aPL-related event was recorded in 8 out of 62 patients (12.9%) during pregnancy: 2 thrombosis and 6 APO. At univariate analysis, factors associated with pregnancy complications were acquired risk factors (p:0.008), non-criteria aPL manifestations (p:0.024), lupus-like manifestations (p:0.013), and triple positive aPL profile (p:0.001). At multivariate analysis, only the association with a triple aPL profile was confirmed (p:0.01, OR 21.3, CI 95% 1.84–247). Patients with triple aPL positivity had a higher rate of pregnancy complications, despite they were more frequently receiving combined treatment of low dose aspirin (LDA) and low molecular weight heparin (LMWH) at prophylactic dose.Conclusion: This study highlights the importance of risk stratification in pregnant aPL carriers, in terms of both immunologic and non-immunologic features. Combination treatment with LDA and LMWH did not prevent APO in some cases, especially in carriers of triple aPL positivity. Triple positive aPL carriers may deserve additional therapeutic strategies during pregnancy.https://www.frontiersin.org/article/10.3389/fimmu.2019.01948/fullantiphospholipid (aPL) antibodiespregnancy complicationadverse pregnancy outcomes (APO)thrombosisanticardiolipin (aCL)lupus anticoagulant |
| spellingShingle | Maria-Grazia Lazzaroni Maria-Grazia Lazzaroni Micaela Fredi Micaela Fredi Laura Andreoli Laura Andreoli Cecilia Beatrice Chighizola Cecilia Beatrice Chighizola Teresa Del Ross Maria Gerosa Maria Gerosa Anna Kuzenko Maria-Gabriella Raimondo Maria-Gabriella Raimondo Andrea Lojacono Andrea Lojacono Francesca Ramazzotto Sonia Zatti Laura Trespidi Pier-Luigi Meroni Vittorio Pengo Amelia Ruffatti Angela Tincani Angela Tincani Angela Tincani Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A Multicenter Study on 62 Pregnancies Frontiers in Immunology antiphospholipid (aPL) antibodies pregnancy complication adverse pregnancy outcomes (APO) thrombosis anticardiolipin (aCL) lupus anticoagulant |
| title | Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A Multicenter Study on 62 Pregnancies |
| title_full | Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A Multicenter Study on 62 Pregnancies |
| title_fullStr | Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A Multicenter Study on 62 Pregnancies |
| title_full_unstemmed | Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A Multicenter Study on 62 Pregnancies |
| title_short | Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A Multicenter Study on 62 Pregnancies |
| title_sort | triple antiphospholipid apl antibodies positivity is associated with pregnancy complications in apl carriers a multicenter study on 62 pregnancies |
| topic | antiphospholipid (aPL) antibodies pregnancy complication adverse pregnancy outcomes (APO) thrombosis anticardiolipin (aCL) lupus anticoagulant |
| url | https://www.frontiersin.org/article/10.3389/fimmu.2019.01948/full |
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