Lupus Science and Medicine (May 2022)
Pregnancy outcomes in antiphospholipid antibody positive patients: prospective results from the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository (‘Registry’)
- ,
- Vittorio Pengo,
- Ricard Cervera,
- Angela Tincani,
- Michelle Petri,
- Jane Salmon,
- Guillermo Ruiz-Irastorza,
- Savino Sciascia,
- Massimo Radin,
- Paul R Fortin,
- Pierluigi Meroni,
- Cecilia Nalli,
- Maria G Tektonidou,
- Laura Andreoli,
- Yu Zuo,
- Denis Wahl,
- Medha Barbhaiya,
- Olga Amengual,
- Hannah Cohen,
- Zhuoli Zhang,
- Guillermo Pons-Estel,
- Ignasi Rodríguez-Pintó,
- Rosario Lopez-Pedrera,
- Maria Gerosa,
- Bahar Artim-Esen,
- Maria Laura Bertolaccini,
- Ann Clarke,
- Roger Levy,
- D Ware Branch,
- LanLan Ji,
- Giulia Pazzola,
- Doruk Erkan,
- Rohan Willis,
- Jason Knight,
- Ecem Sevim,
- Robert Roubey,
- Michael Belmont,
- Ian Mackie,
- Leslie Skeith,
- Zeynep Belce Erton,
- Guilherme Ramires de Jesús,
- Amaia Ugarte,
- Danieli Andrade,
- Maria Angeles Aguirre- Zamorano,
- Michael Lockshin,
- Emilio Gonzalez,
- Cecilia B Chighizola,
- Gustavo Balbi,
- Stephane Zuily,
- Maria Efthymiou,
- Esther Rodgriguez Almaraz,
- Silvia Foddai,
- Nina Kello,
- Jose Pardos-Gea,
- Flavio Signorelli,
- Stacy Davis,
- Zhouli Zhang
Affiliations
- Vittorio Pengo
- Cardiac Thoracic and Vascular Sciences, University of Padova, padua, Italy
- Ricard Cervera
- Autoimmune Diseases, Hospital Clínic de Barcelona Institut Clínic de Medicina i Dermatologia, Barcelona, Spain
- Angela Tincani
- 2 Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Michelle Petri
- 1 Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Jane Salmon
- Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, BioCruces Bizkaia Health Research Institute, University of the Basque Country, Barakaldo, Bizkaia, Spain
- Savino Sciascia
- 17 University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), and Department of Clinical and Biological Sciences of the University of Turin, San Giovanni Bosco Hub Hospital and University of Turin, Turin, Italy
- Massimo Radin
- Paul R Fortin
- Medicine-Rheumatology, Universite Laval, Quebec, Quebec, Canada
- Pierluigi Meroni
- Cecilia Nalli
- Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Laura Andreoli
- 1 Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Yu Zuo
- Internal Medicine/Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
- Denis Wahl
- Medha Barbhaiya
- Olga Amengual
- Hannah Cohen
- Zhuoli Zhang
- Peking University First Hospital, Beijing, China
- Guillermo Pons-Estel
- Ignasi Rodríguez-Pintó
- Rosario Lopez-Pedrera
- Maria Gerosa
- 3 Unit of Clinical Rheumatology, Azienda Socio Sanitaria Territoriale Gaetano Pini, Milano, Italy
- Bahar Artim-Esen
- Department of Internal Medicine, Istanbul University, Fatih, Turkey
- Maria Laura Bertolaccini
- Ann Clarke
- Roger Levy
- D Ware Branch
- professor of obstetrics and gynecology
- LanLan Ji
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, Beijing, China
- Giulia Pazzola
- Doruk Erkan
- Rheumatology, Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Rohan Willis
- Jason Knight
- Ecem Sevim
- Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
- Robert Roubey
- Michael Belmont
- Ian Mackie
- Department of Haematology, University College London, London, UK
- Leslie Skeith
- Zeynep Belce Erton
- Divison of Rheumatology, Hospital for Special Surgery, New York, New York, USA
- Guilherme Ramires de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Amaia Ugarte
- Internal Medicine, Hospital de Cruces, Barkaldo, Spain
- Danieli Andrade
- Rheumatology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
- Maria Angeles Aguirre- Zamorano
- Rheumatology, University Hospital “Reina Sofia”, Cordoba, Spain
- Michael Lockshin
- Emilio Gonzalez
- Cecilia B Chighizola
- Gustavo Balbi
- Stephane Zuily
- Maria Efthymiou
- Esther Rodgriguez Almaraz
- Silvia Foddai
- Nina Kello
- Jose Pardos-Gea
- Flavio Signorelli
- Stacy Davis
- Zhouli Zhang
- DOI
- https://doi.org/10.1136/lupus-2021-000633
- Journal volume & issue
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Vol. 9,
no. 1
Abstract
Objectives To describe the outcomes of pregnancies in antiphospholipid antibody (aPL)-positive patients since the inception of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Registry.Methods We identified persistently aPL-positive patients recorded as ‘pregnant’ during prospective follow-up, and defined ‘aPL-related outcome’ as a composite of: (1) Preterm live delivery (PTLD) at or before 37th week due to pre-eclampsia (PEC), eclampsia, small-for-gestational age (SGA) and/or placental insufficiency (PI); or (2) Otherwise unexplained fetal death after the 10th week of gestation. The primary objective was to describe the characteristics of patients with and without aPL-related composite outcomes based on their first observed pregnancies following registry recruitment.Results Of the 55 first pregnancies observed after registry recruitment among nulliparous and multiparous participants, 15 (27%) resulted in early pregnancy loss <10 weeks gestation. Of the remaining 40 pregnancies: (1) 26 (65%) resulted in term live delivery (TLD), 4 (10%) in PTLD between 34.0 weeks and 36.6 weeks, 5 (12.5%) in PTLD before 34th week, and 5 (12.5%) in fetal death (two associated with genetic anomalies); and (2) The aPL-related composite outcome occurred in 9 (23%). One of 26 (4%) pregnancies with TLD, 3/4 (75%) with PTLD between 34.0 weeks and 36.6 weeks, and 3/5 (60%) with PTLD before 34th week were complicated with PEC, SGA and/or PI. Fifty of 55 (91%) pregnancies were in lupus anticoagulant positive subjects, as well as all pregnancies with aPL-related composite outcome.Conclusion In our multicentre, international, aPL-positive cohort, of 55 first pregnancies observed prospectively, 15 (27%) were complicated by early pregnancy loss. Of the remaining 40 pregnancies, composite pregnancy morbidity was observed in 9 (23%) pregnancies.
