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Epidemiology

Poster Session 3

(886) Non-Criteria Obstetrics Antiphospholipid Syndrome is an independent risk factor for adverse pregnancy outcome

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Shir Luvaton, MD (she/her/hers)

Obstetrics and Gynecology resident
Soroka University Medical Center
Beer-Sheva, HaDarom, Israel

Coauthor(s)

AR

Anat Rabinovich, MD

Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center
Beer Sheva, HaDarom, Israel
RA

Ran Abuhasira, MD, PhD

Clinical Research Center, Soroka University Medical Center
Beer Sheva, HaDarom, Israel
SM

Shayna Miodownik, MD

Hematology Institue, Soroka University Medical Center, HaDarom, Israel

Objective: Non-Criteria Obstetric Antiphospholipid Syndrome (NC-OAPS) includes individuals who fit OAPS clinical criteria but not the Sydney laboratory requirements. The aims of the study were to determine the prevalence of NC-OAPS, antiphospholipid antibodies (APLab) profile, pregnancy outcomes among NC-OAPS and long-term thrombotic and obstetric complications.

Study Design: A population-based retrospective cohort study included all singleton gestations (n=116,409) delivered at our medical center from 1998 to 2020. We defined NC-OAPS patients according to low titers of IgM/IgG anticardiolipin (aCL) or anti-β2-glycoprotein (aβ2GP) antibodies, a single positive lupus anticoagulant test (LAC) or positive IgA antibodies present on two or more occasions at least 12 weeks apart; together with at least one clinical criterion.

Results: The rate of NC-OAPS was 0.22% (258/116409) and of OAPS 0.04% (49/116,409). The most frequent APLab tests were low titers of IgM & IgG aCL and LAC antibodies (33.7%, 35.3, and 35.3% respectively). Women with NC-OAPS had a higher rate of chronic hypertension, hypercholesterolemia, lupus, and aspirin and LMWH treatments than those in the general obstetrical population (GOP) (p< 0.001 for all). In comparison to women with OAPS, the NC-OAPS group had lower median gravidity and parity, a lower rate of lupus and aspirin or LMWH treatments. The rate of obstetric complications prior to and following the diagnosis of OAPS or NC-OAPS did not differ between the groups. The rate of DVT was lower in the NC-OAPS group (p=0.01). In a multivariable Generalized Estimating Equation model adjusting for maternal age, gravidity, and ethnicity, NC-OAPS patients had an independent risk to develop fetal loss, stillbirth, preeclampsia, placental abruption, fetal growth restriction and preterm birth than those in the GOP, which was similar to those with OAPS (Table).

Conclusion: NC-OAPS carries an independent risk for the development of pregnancy complications. These findings have implications on the prenatal follow-up and prevention strategies among women with NC-OAPS.