Complementemia and obstetric outcome in pregnancy with antiphospholipid syndrome

Objective: To investigate the predictive value of serum C3 and C4 complement component levels in relation to pregnancy outcome in patients with antiphospholipid syndrome (APS). Materials and methods: A prospective study of 47 pregnancies associated with APS was performed. Pregnancy outcome was analyzed in terms of: fetal loss, preterm delivery (≤34 gestational weeks), fetal intrauterine growth restriction (IUGR), birth weight <2500 g and preeclampsia. Week at delivery, neonatal birth weight and neonatal birth weight percentile were also investigated. Hypocomplementemia, positivity for anti-dsDNA and triple positivity for antiphospholipid antibodies (aPL) were related to pregnancy outcome. Results: Forty-three pregnancies ended in live births with a fetal loss rate of 8.5%. Fetal death, preterm delivery and birth weight <2500 g were associated with hypocomplementemia (p = 0.019, p = 0.0002, p < 0.0001 respectively). Lower neonatal birth weight, lower neonatal birth weight percentile and lower week at delivery were associated with hypocomplementemia (p < 0.0001, p = 0.0003, p < 0.0001 respectively) and with triple aPL positivity (p = 0.008, p = 0.014, p = 0.03 respectively). A poor pregnancy outcome was confirmed among primary APS (PAPS) pregnancies with hypocomplementemia. Multivariate analysis confirmed that hypocomplementemia was an independent predictor of lower neonatal birth weight (p = 0.0001) and lower week at delivery (p = 0.002). Conclusion: Hypocomplementemia could be considered a novel prognostic factor for pregnancy outcome in APS patients.

[1]  G. Scambia,et al.  False-positive IgM for CMV in pregnant women with autoimmune disease: a novel prognostic factor for poor pregnancy outcome , 2010, Lupus.

[2]  T. Teoh,et al.  Uterine Artery Doppler in Predicting Pregnancy Outcome in Women With Antiphospholipid Syndrome , 2001, Obstetrics and gynecology.

[3]  A. Caruso,et al.  Uterine Artery Velocity Waveforms as Predictors of Pregnancy Outcome in Patients with Antiphospholipid Syndrome , 2007, Annals of the New York Academy of Sciences.

[4]  L. Punzi,et al.  Laboratory and clinical features of pregnant women with antiphospholipid syndrome and neonatal outcome , 2010, Arthritis care & research.

[5]  R. Levy,et al.  Treatment of pregnant patients with antiphospholipid syndrome , 2003, Lupus.

[6]  Xiaowei Liu,et al.  Edinburgh Research Explorer Complement C3 activation is required for antiphospholipid antibody-induced fetal loss , 2022 .

[7]  L. Magder,et al.  The Clinical Utility of Measuring Complement and Anti-dsDNA Antibodies During Pregnancy in Patients with Systemic Lupus Erythematosus , 2011, The Journal of Rheumatology.

[8]  Xiaowei Liu,et al.  Requirement of activation of complement C3 and C5 for antiphospholipid antibody-mediated thrombophilia. , 2005, Arthritis and rheumatism.

[9]  Chan Jun-mi,et al.  International Consensus Statement on an Update of the Classification Criteria for Definite Antiphospholipid Syndrome(APS) , 2008 .

[10]  J. Piette,et al.  The second trimester Doppler ultrasound examination is the best predictor of late pregnancy outcome in systemic lupus erythematosus and/or the antiphospholipid syndrome. , 2006, Rheumatology.

[11]  G. Scambia,et al.  Predictors of Pregnancy Outcome in Antiphospholipid Syndrome: A Review , 2010, Clinical reviews in allergy & immunology.