Characteristics of pregnancy complications and treatment in obstetric antiphospholipid syndrome in China
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Antiphospholipid syndrome (APS) is an autoimmune disease characterized by obstetric complications and thrombotic events associated with antiphospholipid antibodies (aPL). We aimed to compare the clinical characteristics and treatment of primary APS (PAPS) and secondary APS (systemic lupus erythematosus-APS, SAPS) patients and investigate risk factors associated with obstetric complications in Shanghai, China.
We retrospectively collected and analyzed the data of obstetric APS (OAPS) patients from 2000 to 2017 in the APS-Shanghai (APS-SH) database.
One hundred eighty OAPS patients with a total of 450 pregnancies were included in this study. Two hundred twenty-one (49.11%) pregnancies resulted in miscarriage, and 161 (35.77%) pregnancies resulted in intrauterine death. In our cohort, when women were treated, 57 out of 66 pregnancies resulted in live births (86%). Of the 9 treated patients who failed to have live births, 3 had intrauterine deaths, 3 had fetal growth restriction, 2 had pneumorrhagia of the newborn, and 1 had a miscarriage. OAPS patients were divided into two groups: PAPS and SAPS. More SAPS patients than PAPS patients used glucocorticoids (GCs) and hydroxychloroquine (both p < 0.001). However, there was no significant difference in the GC dosage between SAPS and PAPS patients (p = 0.188). Lupus anticoagulant (LAC) and IgG aβ2GPI were risk factors for miscarriage (odds ratio (OR) = 2.398, 95% confidence interval (CI) = 1.276–4.505, p = 0.002; OR = 2.907, 95% CI = 1.558–5.405, p = 0.001, respectively) and intrauterine death (OR = 2.439, 95% CI = 1.299–4.580, p = 0.006; OR = 2.060, 95% CI = 1.089–3.897, p = 0.026, respectively).
• This is the first study to report data on Chinese OAPS patients. The live birth rate was 86%.
• Lupus anticoagulant and IgG aβ2GPI were risk factors for miscarriage and intrauterine death in our cohort.
• Despite active treatment, 9 patients had obstetric complications. Therefore, further second-line treatment is still needed.
KeywordsAntiphospholipid antibodies Obstetric antiphospholipid syndrome Pregnancy Treatment.
We would like to thank Fan Wang, Hui Shi, and Jieyu Gu who helped in collecting the clinical data and Jian Li who helped in performing the statistical analysis.
This work is financially supported by the National Natural Science Foundation of China (81671589, 81871272, 81801592), Shanghai Sailing Program (18YF1414100), Shanghai Jiao Tong University Interdisciplinary Research Project (YG2016QN60), and Excellent Youth B Project (GCQN-2017-B05).
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