Background Antiphospholipid antibodies (aPLs) are the leading causes of adverse pregnancy outcomes (APO). Women with persistently aPLs positive present heterogeneous clinical manifestations and APO. We applied cluster analysis to identify specific phenotypes among these patients to manage risk stratification during pregnancy and improve prognosis.
Methods This was a prospective study of persistent aPLs-positive women cohort to PUMCH between July 2009 and February 2022. Demographic characteristics, clinical manifestation, previous pregnancy history and antibodies profiles were recorded. Hierarchical cluster analysis and Chi-square test were performed.
Results A total of 209 patients with 477 pregnancies were enrolled in this study. β2GPI was the most frequently found in persistent aPLs-positive women. The live birth rate improved from 17.29% before enrollment to 75.64% dramatically (table 1). Three clusters among 209 patients were identified. Cluster 1 (60 patients, 28.71%) consisted mainly of women with SLE and major presented aPLs IgG subtype. Women in this group had the highest incidence of pregnancy induced hypertension and late miscarriage (LM) events. Cluster 2 (70 patients, 33.49%) presented IgG subtypes with the highest percentage of placenta insufficiency (PI). Cluster 3 (79 patients, 37.80%) showed the highest prevalence of IgM subtype of aPLs (87.34%,36.71%, respectively). Women in this cluster suffered highest frequency of early miscarriage (EM) (62.03%). After standard treatment, the live birth rate of cluster 1 patients was only 69.2%, much lower than the other two clusters. Placental pathology also suggested severe foci of infarction and calcification in cluster 1 (figure 1).
Conclusions Our study identified three clinical subtypes of aPLs-positive women with APO. Cluster 1 contains patients with a predisposition to SLE. Patients in cluster 2 majorly present PI combined with aPLs-IgG subtype, while cluster 3 present EM with aPLs-IgM subtype. The individualized risk stratification assessment of these patients will help to develop different treatment strategies and improve the pregnancy outcome.
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