The study of antiphospholipid antibodies in recurrent pregnancy loss

Authors

  • Sheela H. S. Department of Obstetrics and Gynecology, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, Karnataka, India
  • Lakshmidevi M. Department of Obstetrics and Gynecology, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, Karnataka, India
  • Babitha Koganti Department of Obstetrics and Gynecology, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, Karnataka, India
  • Shreedhar Venkatesh Department of Obstetrics and Gynecology, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20175039

Keywords:

APLA (Anti phospholipid antibody), ACA (Anti cardiolipin antibody), Lupus anticoagulant (LA), POG (Period of gestation)

Abstract

Background: Around 15% of clinically recognised pregnancies in women less than 35 years old result in spontaneous miscarriage. However recurrent pregnancy loss (RPL) is encountered in 5% of couples with two or more losses and in around 1–2% of couples with three or more losses. In view of the increasing burden of recurrent pregnancy loss in the society and in view of Anti-phospholipid syndrome being one of the undisputed treatable cause for recurrent pregnancy loss, this study aims to evaluate the significance of the antibody profiles of APS in relation to RPL in OBG dept of VIMS and RC.

Methods: Patients coming to the Obstetric and Gynaecology department of Vydehi Institute of Medical Sciences and Research Centre, Bangalore, from December 1st 2014 to June 30th 2016. A detailed history of patients was taken based on set questionnaires. Detailed general and gynaecological examination findings were taken. Routine blood investigations were sent along with investigations for aPLAs which included: - Lupus Anticoagulant (LA) - Anti Cardiolipin Antibody (ACA) - Anti β2 glycoprotein 1 (Anti-β2GP1Ab). Final results are statistically evaluated.

Results: A total of 56 patients of recurrent miscarriage with two or more prior pregnancy losses were considered. Out of the 56 patients, 23 patients were excluded as per the exclusion criteria and 33 patients were included in the present study. The mean age of the study group was 24.63 years (Range: 20-32 years). Overall, seven patients (21.21%) were seen to have positive antiphospholipid antibody titers amongst the 33 patients, with repeat testing done after 12 weeks to confirm the positivity. Five patients (15.15%) were positive for ACA antibody. Four (12.12%) patients were positive for LA and B2GP1 each. Two patients (6.06%) were positive for both LA and ACA antibodies. Two patients (6.06%) were positive for LA and B2GP1 antibodies and two other (6.06%) patients were positive for ACA and Anti-β2GP1Ab. There was a statistically significant association noticed between ACA positivity and POG at 1st pregnancy loss. However, the overall association of APLA positivity and POG at pregnancy loss was not statistically significant.

Conclusions: There was a significant difference of POG at first pregnancy loss in ACA positive patients as compared to the ACA negative patients. However, when all the APLA positive patients were considered the difference was not statistically significant.

References

Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012;98(5):1103-11.

Jauniaux E, Farquharson RG, Christiansen OB, Exalto N. Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage. Hum Reprod. 2006;21:2216-22.

Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss. Fertil Steril. 2013;99(1):63-67.

De Stefano V, Chiusolo P, Paciaroni K, Leone G. Epidemiology of factor V Leiden: clinical implications. Semin Thromb Hemost. 1998;24(4):367-79.

Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps et al. Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum. 2002;46:1019-27.

Pradhan T, Bhavthankar DP. An observational study of causes of recurrent pregnancy loss in rural Population. Indian J Basic Appl Med Res. 2014;4(1):70-6.

Yetman DL, Kutteh WH. Antiphospholipid antibody panels and recurrent pregnancy loss: prevalence of anticardiolipin antibodies compared with other antiphospholipid antibodies. Fertil Steril. 1996 Oct;66(4):540-6.

Sater M, Almawi W. Autoantibodies targeting phosphatidylserine, cardiolipin, β2-glycoprotein I, annexin V and prothrombin in patients with recurrent spontaneous miscarriage (148.18). J Immunol. 2011 Apr 1;186(1 Supplement):148.

Ghosh A, Ghosh M, Bhattacharya SM. Anti-phospholipid antibodies as a cause of recurrent pregnancy loss: a study in Calcutta, India. Journal of Obstetrics and Gynaecology. 2009 Jul;26(5):407-10.

Al-Hilli NM, Al-Mosawi HM. The prevalence of anticardiolipin antibodies in women with bad obstetric history. Int J Curr Microbiol App Sci. 2014;3(2):547-3.

Nizamani GS, Memon RA, Kazi N, Khoharo HK, Kazi S. Anticardiolipin antibodies in women having recurrent spontaneous abortions. Pak J Physiol. 2015;11(3):38-9.

Stern C, Chamley L, Hale L, Kloss M, Speirs A, Baker HWG. Antibodies to β2 glycoprotein I are associated with in vitro fertilization implantation failure as well as recurrent miscarriage: results of a prevalence study. Fertil Steril. 1998 Nov;70(5):938-44.

Ames PR, Nourooz-Zadeh J, Tomma- sino C, Alves J, Brancaccio V, Anggard EE. Oxidative stress in primary antiphospho- lipid syndrome. Thromb Haemost. 1998;79:447-9.

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Published

2017-10-28

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Original Research Articles