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Abstract
Purpose To compare clinical, laboratory, treatment, and adverse pregnancy outcomes, and live birth rate data in women with persistently positive antiphospholipid antibodies in China.
Methods Patients with persistent aPLs (lupus anticoagulant [LAC], anticardiolipin antibody [aCL], and/or antibody to β2-glycoprotein I [anti-_2GPI]) positive were recruited for the present prospective study from Peking Union Medical College Hospital. Demographic, clinical, serologic, treatment and pregnant data were recorded at the time of the first study visit. Student’s t-test was used to compare values following normal distribution, while Mann-Whitney-Wilcoxon’s test was used for data not following a normal distribution. Chi-square test and Fisher’s exact test were used to compare categorical variables.
Results Between 2009 and 2021 we enrolled 513 pregnant patients, of whom 212 had adverse pregnancy outcomes with persistent aPLs-positive. A total of 454 pregnancies occurred in our center. The live birth rate before enrollment was 27.71% (110/397), and after enrollment, the live birth rate increased to 61.4% (35/57). 41.5% (n=88) had isolated early miscarriages, similar to the percentage of isolated middle and later period APO (n=92, 43.4%). Only 32 patients had both early and late APO. Among the isolated early miscarriage group, over half of patients had one miscarriage (n=50), and 22 patients had twice. However, eighteen percentage patients had three consecutive miscarriages, which accords with the 2006 Sydney APS diagnosis. In the late APO group, most patients can be diagnosed with APS (n=81, 88%). Among all adverse pregnancy events, we found that fetal loss was the most important type (n=182, 40.1%), followed by pregnancy-induced hypertension, with 22 times preeclampsia and three times eclampsia. In third place was preterm birth, there was no difference in the proportion of preterm births before or after 34 weeks.
Flowchart of the study (persistence aPLs positive APO women in PUMCH)
Proportion of APO in different periods
Proportion of different type of APO
Conclusion In this study, a significant increase in the live birth rate was shown after aPLs were identified. Fetal loss especially late period miscarriage is the most frequent poor outcome. Most patients in this group meet the diagnosis of APS. Patients with early miscarriage, although only 18.2% of them may diagnose with APS, should also be treated if patients suffered two consecutive miscarriages to obtain a better pregnancy outcome.
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