Pregnancy and Clinical Outcome Among Women with Antiphospholipid Antibody Syndrome—A Tertiary Care Center–Based Observational Study

Abstract

Antiphospholipid antibody syndrome (APS) is an acquired thrombophilia with multisystem involvement. This study was undertaken to study the antibody profile of pregnant women with APS and their pregnancy outcomes. This retrospective study was conducted in a tertiary care teaching institute in Southern India. Data of 231 APS-positive pregnancies in 104 women were analyzed in this study. The primary outcome was to study the adverse outcomes such as abortions, intrauterine fetal death, neonatal death, maternal thrombotic events, and preeclampsia in APS-complicated pregnancies. Secondary outcomes were to study the adverse clinical outcomes in comparison to various antiphospholipid antibodies; primary versus secondary APS; and obstetric versus thrombotic APS. Anticardiolipin antibody (ACLA) (n = 157, 68%) was the most common antibody identified followed by lupus anticoagulant (LA) (n = 80, 34.6%) and beta-2-glycoprotein (B2GP) (n = 48, 20.8%). B2GP positivity was associated with higher fetal growth restriction (FGR) (66.7% vs 36.3% vs 32.6%, p value 0.05) and stillbirth (30% vs 9.5% vs 13%, p 0.004) in comparison to ACLA and LA. Multiple antibody positivity was associated with a significantly higher first trimester losses (55.2% first trimester loss in double positive versus 43.2% in single antibody positive group; p 0.004). Thrombotic APS was associated with higher rates of intrauterine growth–restricted fetuses than obstetric APS (35.2% vs 55.9%, p 0.032). ACLA is the most common antibody identified in the APS-positive pregnancies in Southern Indian population. The adverse pregnancy outcomes were higher in multiple antibody positivity and B2GP group.