Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 14 , ISSUE 5 ( September-October, 2022 ) > List of Articles

Original Article

Prevalence of Antiphospholipid Antibodies in Patients with Bad Obstetric History of unknown Etiology and Its Association with Clinical Parameters

Sambedana Panigrahi, Saumya Ranjan Tripathy, Maya Padhi, Rina Tripathy, Bidyut Kumar Das

Keywords : Antiphospholipid antibodies, Bad obstetric history, Hypertension, Thrombocytopenia, Thrombosis

Citation Information : Panigrahi S, Tripathy SR, Padhi M, Tripathy R, Das BK. Prevalence of Antiphospholipid Antibodies in Patients with Bad Obstetric History of unknown Etiology and Its Association with Clinical Parameters. J South Asian Feder Obs Gynae 2022; 14 (5):514-518.

DOI: 10.5005/jp-journals-10006-2118

License: CC BY-NC 4.0

Published Online: 16-11-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Antiphospholipid syndrome (APS) is one of the important treatable causes of bad obstetric history (BOH). The literature on the association between the presence of antiphospholipid antibodies (APLA) in patients with BOH and clinical parameters is limited. Aims and objectives: (1) To estimate the prevalence of APLA in patients with BOH and (2) To determine the association of APLA with various clinical parameters in patients with BOH. Materials and methods: A total of 80 patients with BOH of unknown etiology and 40 age-matched controls with at least 1 successful pregnancy outcome were clinically assessed and screened for the presence of APLA {anti-β2 glycoprotein-1-IgG (ABGP1-IgG); anticardiolipin IgG and IgM [anticardiolipin antibodies (ACLA), ACLA-IgG and -IgM)]; and lupus anticoagulant (LAC)}. The clinical parameters of APLA-positive and APLA-negative cases were compared. Results: Antiphospholipid antibodies were detected in 12 of 80 cases (15%) compared with none among controls [odds ratio (OR) = 29.38; 95% confidence interval (CI) = 1.71–505.4; p = 0.0199]. The antibody ABGP1-IgG was the commonest one (n = 7, 58.33%) followed by LAC (n = 4, 33.33%) and ACLA-IgG and -IgM (1 each). Patients with APLA-positive BOH had significantly increased incidence of thrombotic episodes (p = 0.01), hypertension (p = 0.05), thrombocytopenia p <0.01), and anemia (9.67 ± 1.75 vs 11.04 ± 1.37 gm/dL; p <0.01). Second-trimester abortion was significantly higher (p = 0.03), and first-trimester abortions were significantly lesser (p = 0.02) compared with patients with APLA-negative BOH. Third-trimester adverse obstetric events were comparable between the two groups. Conclusion: Antiphospholipid antibodies are present in 15% of patients with BOH of unknown etiology. History of thrombosis, hypertension, thrombocytopenia, anemia, and second-trimester abortions were significantly associated with the presence of APLA in BOH. Clinical significance: The findings from this study will help in determining the subset of patients with BOH who have higher likelihood of presence of APLA and therefore increase the chances of treatment and a successful pregnancy outcome.


PDF Share
  1. Singh G, Sidhu K. Bad obstetric history: A prospective study. Med J Armed Forces India 2010;66(2):117–1120. DOI: 10.1016/S0377-1237(10) 80121-2.
  2. Lathi RB, Schust DJ. Recurrent pregnancy loss. In: Berek JS, editor. Berek and Novak's Gynecology. Philadelphia: Lippincott Wilkins and Williams; 2012. pp.2636–2734.
  3. Garcia D, Erkan D. Diagnosis and management of the antiphospholipid syndrome. N Engl J Med 2018;378(21):2010–2021. DOI: 10.1056/NEJ Mra1705454.
  4. Qi Y, Zhu S, Li C, et al. Seroepidemiology of TORCH antibodies in the reproductive-aged women in China. Eur J Obstet Gynecol Reprod Biol 2020;254:114–118. DOI: 10.1016/j.ejogrb.2020.09.010. DOI: 10.1016/j.ejogrb.2020.09.010.
  5. Rai RS, Regan L, Clifford K, et al. Antiphospholipid antibodies and β2-glycoprotein-I in 500 women with recurrent miscarriage. Results of a comprehensive screening approach. Hum Reprod 1995;10: 2001–2005. DOI: 10.1093/oxfordjournals.humrep.a136224.
  6. Bowman ZS, Wunsche V, Porter TF, et al. Prevalence of antiphospholipid antibodies and risk of subsequent adverse obstetric outcomes in women with prior pregnancy loss. J Reprod Immunol 2015;107:59–63. DOI: 10.1016/j.jri.2014.09.052.
  7. Sharma A, Yadav S, Yadav P. Study of antiphospholipid syndrome in patients with bad obstetric history: A cross-sectional study. Int J Clin Obstet Gynaecol 2018;2(2):24–28. https://www.gynaecologyjournal.com/articles/53/2-1-23-570.pdf.
  8. Ghosh A, Ghosh M, Bhattacharya SM. Antiphospholipid antibodies as a cause of recurrent pregnancy loss: a study in Calcutta, India. J Obstet Gynaecol 2006;26(5):407–410. DOI: 10.1080/01443610600 719974.
  9. Cervera R, Boffa MC, Khamashta MA, et al. The Euro–Phospholipid project: Epidemiology of the antiphospholipid syndrome in Europe. Lupus. 2009;18:889–893. DOI: 10.1177/0961203309106832.
  10. Saccone G, Berghella V, Maruotti GM, et al. Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome: The PREGNANTS study. Am J Obstet Gynecol 2017;216(5):525.e1–525.e12. DOI: 10.1016/j.ajog.2017.01.026.
  11. Chandran V, Aggarwal A, Misra R. Active disease during pregnancy is associated with poor foetal outcome in Indian patients with systemic lupus erythematosus. Rheumatol Int 2005;26(2):152–156. DOI: 10.1007/s00296-004-0540-3.
  12. Kaneria MV, Vishwanathan C. A preliminary study of antiphospholipid antibodies in 50 cases of bad obstetric history. J Assoc Physicians India 1999;47(7):669–672. PMID: 10778583.
  13. Pignatelli P, Ettorre E, Menichelli D, et al. Seronegative antiphospholipid syndrome: refining the value of “non-criteria” antibodies for diagnosis and clinical management. Haematologica 2020;105(3):562–572. DOI: 10.3324/haematol.2019.221945.
  14. Liu L, Sun D. Pregnancy outcomes in patients with primary antiphospholipid syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(20):e15733. DOI: 10.1097/MD.000000 0000015733.
  15. Turrent-Carriles A, Herrera-Félix JP, Amigo MC. Renal involvement in antiphospholipid syndrome. Front Immunol 2018;9:1008. DOI: 10.3389/fimmu.2018.01008.
  16. Allison JL, Schust DJ. Recurrent first trimester pregnancy loss: revised definitions and novel causes. Curr Opin Endocrinol Diabetes Obes 2009;16:446–450. DOI: 10.1097/MED.0b013e3283327fc5.
  17. Out HJ, Bruinse HW, Christiaens GCML, et al. A prospective, controlled multicenter study on the obstetric risks of pregnant women with antiphospholipid antibodies. Am J Obstet Gynecol 1992;167(1): 26–32. DOI: 10.1016/s0002-9378(11)91619-6.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.