Lupus anticoagulant is the main predictor of adverse pregnancy outcomes in aPL-positive patients

Validation of PROMISSE study results

Cecile M. Yelnik, Carl A. Laskin, T. Flint Porter, D. Ware Branch, Jill P. Buyon, Marta M. Guerra, Michael D. Lockshin, Michelle Petri, Joan T. Merrill, Lisa R. Sammaritano, Mimi Kim, Jane E. Salmon

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective We previously reported that lupus anticoagulant (LAC) is the main predictor of poor pregnancy outcome in antiphospholipid antibody (aPL)-positive patients. We sought to confirm this finding in an independent group of patients who were subsequently recruited into the PROMISSE study. Methods The PROMISSE study is a multicentre, prospective, observational study of pregnancy outcomes in women with aPL and/or systemic lupus erythematosus (SLE) that enrolled patients from 2003 to 2015. All consecutive, aPL-positive patients from the PROMISSE study who completed their pregnancy between April 2011 and January 2015 (after the previous PROMISSE report) are included in the current report. Patients were followed monthly until delivery, and aPL was tested at first, second and third trimesters of pregnancy and at 12 weeks post partum. Adverse pregnancy outcomes (APOs) were defined as fetal death after 12 weeks of gestation, neonatal death, delivery prior to 36 weeks of gestation due to pre-eclampsia or placental insufficiency or small-for-gestational age (birth weight <5th percentile). Results Forty-four aPL-positive patients are included in this paper. Thirteen patients had APOs, which occurred in 80% of cases during the second trimester of pregnancy. LAC was present in 69% of patients with APOs compared with 27% of patients without APOs (p=0.01). No association was found between anticardiolipin antibodies (aCL) or anti-β2 glycoprotein I antibodies (aβ2GPI) IgG or IgM positivity and APOs. Definite antiphospholipid syndrome (history of thrombosis and/or pregnancy morbidity and aPL) was found in 92% of patients with any APOs compared with 45% of patients without APOs (p=0.004). Conversely, the frequency of SLE was not statistically different between those with and without APOs (30% vs 39%). Conclusions Our findings, in an independent group of aPL-positive patients from the PROMISSE study, confirm that LAC, but not aCL and aβ2GPI, is predictive of poor pregnancy outcomes after 12 weeks of pregnancy. Trial registration number NCT00198068.

Original languageEnglish (US)
Article numbere000131
JournalLupus Science and Medicine
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2016

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Lupus Coagulation Inhibitor
Antiphospholipid Antibodies
Validation Studies
Pregnancy Outcome
Pregnancy
Anticardiolipin Antibodies
Second Pregnancy Trimester
Systemic Lupus Erythematosus
Glycoproteins
Placental Insufficiency
Fetal Death
Antiphospholipid Syndrome
Antibodies
Third Pregnancy Trimester
First Pregnancy Trimester
Pre-Eclampsia
Birth Weight
Gestational Age
Observational Studies
Immunoglobulin M

Keywords

  • Antiphospholipid Antibodies
  • Antiphospholipid Syndrome
  • Lupus Anticoagulant
  • Pregnancy
  • Systemic Lupus Erythematosus

ASJC Scopus subject areas

  • Immunology

Cite this

Yelnik, C. M., Laskin, C. A., Porter, T. F., Branch, D. W., Buyon, J. P., Guerra, M. M., ... Salmon, J. E. (2016). Lupus anticoagulant is the main predictor of adverse pregnancy outcomes in aPL-positive patients: Validation of PROMISSE study results. Lupus Science and Medicine, 3(1), [e000131]. https://doi.org/10.1136/lupus-2015-000131

Lupus anticoagulant is the main predictor of adverse pregnancy outcomes in aPL-positive patients : Validation of PROMISSE study results. / Yelnik, Cecile M.; Laskin, Carl A.; Porter, T. Flint; Branch, D. Ware; Buyon, Jill P.; Guerra, Marta M.; Lockshin, Michael D.; Petri, Michelle; Merrill, Joan T.; Sammaritano, Lisa R.; Kim, Mimi; Salmon, Jane E.

In: Lupus Science and Medicine, Vol. 3, No. 1, e000131, 01.01.2016.

Research output: Contribution to journalArticle

Yelnik, CM, Laskin, CA, Porter, TF, Branch, DW, Buyon, JP, Guerra, MM, Lockshin, MD, Petri, M, Merrill, JT, Sammaritano, LR, Kim, M & Salmon, JE 2016, 'Lupus anticoagulant is the main predictor of adverse pregnancy outcomes in aPL-positive patients: Validation of PROMISSE study results', Lupus Science and Medicine, vol. 3, no. 1, e000131. https://doi.org/10.1136/lupus-2015-000131
Yelnik, Cecile M. ; Laskin, Carl A. ; Porter, T. Flint ; Branch, D. Ware ; Buyon, Jill P. ; Guerra, Marta M. ; Lockshin, Michael D. ; Petri, Michelle ; Merrill, Joan T. ; Sammaritano, Lisa R. ; Kim, Mimi ; Salmon, Jane E. / Lupus anticoagulant is the main predictor of adverse pregnancy outcomes in aPL-positive patients : Validation of PROMISSE study results. In: Lupus Science and Medicine. 2016 ; Vol. 3, No. 1.
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abstract = "Objective We previously reported that lupus anticoagulant (LAC) is the main predictor of poor pregnancy outcome in antiphospholipid antibody (aPL)-positive patients. We sought to confirm this finding in an independent group of patients who were subsequently recruited into the PROMISSE study. Methods The PROMISSE study is a multicentre, prospective, observational study of pregnancy outcomes in women with aPL and/or systemic lupus erythematosus (SLE) that enrolled patients from 2003 to 2015. All consecutive, aPL-positive patients from the PROMISSE study who completed their pregnancy between April 2011 and January 2015 (after the previous PROMISSE report) are included in the current report. Patients were followed monthly until delivery, and aPL was tested at first, second and third trimesters of pregnancy and at 12 weeks post partum. Adverse pregnancy outcomes (APOs) were defined as fetal death after 12 weeks of gestation, neonatal death, delivery prior to 36 weeks of gestation due to pre-eclampsia or placental insufficiency or small-for-gestational age (birth weight <5th percentile). Results Forty-four aPL-positive patients are included in this paper. Thirteen patients had APOs, which occurred in 80{\%} of cases during the second trimester of pregnancy. LAC was present in 69{\%} of patients with APOs compared with 27{\%} of patients without APOs (p=0.01). No association was found between anticardiolipin antibodies (aCL) or anti-β2 glycoprotein I antibodies (aβ2GPI) IgG or IgM positivity and APOs. Definite antiphospholipid syndrome (history of thrombosis and/or pregnancy morbidity and aPL) was found in 92{\%} of patients with any APOs compared with 45{\%} of patients without APOs (p=0.004). Conversely, the frequency of SLE was not statistically different between those with and without APOs (30{\%} vs 39{\%}). Conclusions Our findings, in an independent group of aPL-positive patients from the PROMISSE study, confirm that LAC, but not aCL and aβ2GPI, is predictive of poor pregnancy outcomes after 12 weeks of pregnancy. Trial registration number NCT00198068.",
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AU - Porter, T. Flint

AU - Branch, D. Ware

AU - Buyon, Jill P.

AU - Guerra, Marta M.

AU - Lockshin, Michael D.

AU - Petri, Michelle

AU - Merrill, Joan T.

AU - Sammaritano, Lisa R.

AU - Kim, Mimi

AU - Salmon, Jane E.

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N2 - Objective We previously reported that lupus anticoagulant (LAC) is the main predictor of poor pregnancy outcome in antiphospholipid antibody (aPL)-positive patients. We sought to confirm this finding in an independent group of patients who were subsequently recruited into the PROMISSE study. Methods The PROMISSE study is a multicentre, prospective, observational study of pregnancy outcomes in women with aPL and/or systemic lupus erythematosus (SLE) that enrolled patients from 2003 to 2015. All consecutive, aPL-positive patients from the PROMISSE study who completed their pregnancy between April 2011 and January 2015 (after the previous PROMISSE report) are included in the current report. Patients were followed monthly until delivery, and aPL was tested at first, second and third trimesters of pregnancy and at 12 weeks post partum. Adverse pregnancy outcomes (APOs) were defined as fetal death after 12 weeks of gestation, neonatal death, delivery prior to 36 weeks of gestation due to pre-eclampsia or placental insufficiency or small-for-gestational age (birth weight <5th percentile). Results Forty-four aPL-positive patients are included in this paper. Thirteen patients had APOs, which occurred in 80% of cases during the second trimester of pregnancy. LAC was present in 69% of patients with APOs compared with 27% of patients without APOs (p=0.01). No association was found between anticardiolipin antibodies (aCL) or anti-β2 glycoprotein I antibodies (aβ2GPI) IgG or IgM positivity and APOs. Definite antiphospholipid syndrome (history of thrombosis and/or pregnancy morbidity and aPL) was found in 92% of patients with any APOs compared with 45% of patients without APOs (p=0.004). Conversely, the frequency of SLE was not statistically different between those with and without APOs (30% vs 39%). Conclusions Our findings, in an independent group of aPL-positive patients from the PROMISSE study, confirm that LAC, but not aCL and aβ2GPI, is predictive of poor pregnancy outcomes after 12 weeks of pregnancy. Trial registration number NCT00198068.

AB - Objective We previously reported that lupus anticoagulant (LAC) is the main predictor of poor pregnancy outcome in antiphospholipid antibody (aPL)-positive patients. We sought to confirm this finding in an independent group of patients who were subsequently recruited into the PROMISSE study. Methods The PROMISSE study is a multicentre, prospective, observational study of pregnancy outcomes in women with aPL and/or systemic lupus erythematosus (SLE) that enrolled patients from 2003 to 2015. All consecutive, aPL-positive patients from the PROMISSE study who completed their pregnancy between April 2011 and January 2015 (after the previous PROMISSE report) are included in the current report. Patients were followed monthly until delivery, and aPL was tested at first, second and third trimesters of pregnancy and at 12 weeks post partum. Adverse pregnancy outcomes (APOs) were defined as fetal death after 12 weeks of gestation, neonatal death, delivery prior to 36 weeks of gestation due to pre-eclampsia or placental insufficiency or small-for-gestational age (birth weight <5th percentile). Results Forty-four aPL-positive patients are included in this paper. Thirteen patients had APOs, which occurred in 80% of cases during the second trimester of pregnancy. LAC was present in 69% of patients with APOs compared with 27% of patients without APOs (p=0.01). No association was found between anticardiolipin antibodies (aCL) or anti-β2 glycoprotein I antibodies (aβ2GPI) IgG or IgM positivity and APOs. Definite antiphospholipid syndrome (history of thrombosis and/or pregnancy morbidity and aPL) was found in 92% of patients with any APOs compared with 45% of patients without APOs (p=0.004). Conversely, the frequency of SLE was not statistically different between those with and without APOs (30% vs 39%). Conclusions Our findings, in an independent group of aPL-positive patients from the PROMISSE study, confirm that LAC, but not aCL and aβ2GPI, is predictive of poor pregnancy outcomes after 12 weeks of pregnancy. Trial registration number NCT00198068.

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