Preconception antiphospholipid antibodies and risk of subsequent early pregnancy loss

Karen Gibbins, S. L. Mumford, L. A. Sjaarda, D. W. Branch, N. J. Perkins, A. Ye, E. F. Schisterman, R. M. Silver

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: To prospectively estimate the association of preconception antiphospholipid antibodies (aPL) with subsequent pregnancy loss using a cohort design. aPL have been associated with recurrent early pregnancy loss (EPL) prior to 10 weeks in previous case-control studies. Prospective ascertainment of pregnancy loss is challenging, as most women do not seek care prior to EPL. Methods: Secondary analysis of the Effects of Aspirin in Gestation and Reproduction trial of preconception low-dose aspirin. Preconception anticardiolipin (aCL) and anti-β2-glycoprotein-I (a-β2-I) were assessed in 1208 women with one or two prior pregnancy losses and no more than two prior live births. Comparison cohorts were defined by positive aPL (+aPL) or negative aPL (–aPL) status. All women were followed for six menstrual cycles while trying to conceive; if successful, they underwent an ultrasound at 6–7 weeks’ gestation. EPL was defined as loss prior to 10 weeks’ gestation; embryonic loss was loss after visualization of an embryo but prior to 10 weeks; clinical loss was any loss after visualization of an embryo (with or without fetal cardiac activity detected). Results: In total, 14/1208 (1%) tested positive for +aPL. 786/1208 (65%) women had positive human chorionic gonadotropin during the study period, of which 9/786 (1%) had +aPL. Of the 786 pregnant women, 589 (75%) had live births and 24% had pregnancy losses. Women with +aPL experienced EPL at similar rates as women with –aPL, 44% vs 21% (aRR 2.4, 95% confidence interval (CI) 0.5–10.9). Embryonic loss was more common in women with +aCL IgM (aRR 4.8, 95% CI 1.0–23.0) and in women with two positive aPL. Clinical pregnancy loss was more common in women with positive a-β2-I IgM (50% vs 16.5%, aRR 3.7, 95% CI 1.3–10.8). Conclusion: Positive levels of aPL are rare in women with one or two prior pregnancy losses and are not clearly associated with an increased rate of subsequent loss. Clinical trial registration: The original source study was registered at ClinicalTrials.gov (#NCT00467363).

Original languageEnglish (US)
Pages (from-to)1437-1445
Number of pages9
JournalLupus
Volume27
Issue number9
DOIs
StatePublished - Aug 1 2018
Externally publishedYes

Fingerprint

Antiphospholipid Antibodies
Pregnancy
Live Birth
Confidence Intervals
Aspirin
Immunoglobulin M
Glycoproteins
Embryonic Structures
Fetal Movement
Chorionic Gonadotropin
Menstrual Cycle
Reproduction
Case-Control Studies
Pregnant Women

Keywords

  • Anticardiolipin antibodies
  • antiphospholipid syndrome
  • pregnancy

ASJC Scopus subject areas

  • Rheumatology

Cite this

Gibbins, K., Mumford, S. L., Sjaarda, L. A., Branch, D. W., Perkins, N. J., Ye, A., ... Silver, R. M. (2018). Preconception antiphospholipid antibodies and risk of subsequent early pregnancy loss. Lupus, 27(9), 1437-1445. https://doi.org/10.1177/0961203318776089

Preconception antiphospholipid antibodies and risk of subsequent early pregnancy loss. / Gibbins, Karen; Mumford, S. L.; Sjaarda, L. A.; Branch, D. W.; Perkins, N. J.; Ye, A.; Schisterman, E. F.; Silver, R. M.

In: Lupus, Vol. 27, No. 9, 01.08.2018, p. 1437-1445.

Research output: Contribution to journalArticle

Gibbins, K, Mumford, SL, Sjaarda, LA, Branch, DW, Perkins, NJ, Ye, A, Schisterman, EF & Silver, RM 2018, 'Preconception antiphospholipid antibodies and risk of subsequent early pregnancy loss', Lupus, vol. 27, no. 9, pp. 1437-1445. https://doi.org/10.1177/0961203318776089
Gibbins K, Mumford SL, Sjaarda LA, Branch DW, Perkins NJ, Ye A et al. Preconception antiphospholipid antibodies and risk of subsequent early pregnancy loss. Lupus. 2018 Aug 1;27(9):1437-1445. https://doi.org/10.1177/0961203318776089
Gibbins, Karen ; Mumford, S. L. ; Sjaarda, L. A. ; Branch, D. W. ; Perkins, N. J. ; Ye, A. ; Schisterman, E. F. ; Silver, R. M. / Preconception antiphospholipid antibodies and risk of subsequent early pregnancy loss. In: Lupus. 2018 ; Vol. 27, No. 9. pp. 1437-1445.
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abstract = "Objectives: To prospectively estimate the association of preconception antiphospholipid antibodies (aPL) with subsequent pregnancy loss using a cohort design. aPL have been associated with recurrent early pregnancy loss (EPL) prior to 10 weeks in previous case-control studies. Prospective ascertainment of pregnancy loss is challenging, as most women do not seek care prior to EPL. Methods: Secondary analysis of the Effects of Aspirin in Gestation and Reproduction trial of preconception low-dose aspirin. Preconception anticardiolipin (aCL) and anti-β2-glycoprotein-I (a-β2-I) were assessed in 1208 women with one or two prior pregnancy losses and no more than two prior live births. Comparison cohorts were defined by positive aPL (+aPL) or negative aPL (–aPL) status. All women were followed for six menstrual cycles while trying to conceive; if successful, they underwent an ultrasound at 6–7 weeks’ gestation. EPL was defined as loss prior to 10 weeks’ gestation; embryonic loss was loss after visualization of an embryo but prior to 10 weeks; clinical loss was any loss after visualization of an embryo (with or without fetal cardiac activity detected). Results: In total, 14/1208 (1{\%}) tested positive for +aPL. 786/1208 (65{\%}) women had positive human chorionic gonadotropin during the study period, of which 9/786 (1{\%}) had +aPL. Of the 786 pregnant women, 589 (75{\%}) had live births and 24{\%} had pregnancy losses. Women with +aPL experienced EPL at similar rates as women with –aPL, 44{\%} vs 21{\%} (aRR 2.4, 95{\%} confidence interval (CI) 0.5–10.9). Embryonic loss was more common in women with +aCL IgM (aRR 4.8, 95{\%} CI 1.0–23.0) and in women with two positive aPL. Clinical pregnancy loss was more common in women with positive a-β2-I IgM (50{\%} vs 16.5{\%}, aRR 3.7, 95{\%} CI 1.3–10.8). Conclusion: Positive levels of aPL are rare in women with one or two prior pregnancy losses and are not clearly associated with an increased rate of subsequent loss. Clinical trial registration: The original source study was registered at ClinicalTrials.gov (#NCT00467363).",
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