The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): a preliminary first year report.

BACKGROUND: Obstetric morbidity (OM) is a common feature of antiphospholipid syndrome (OAPS). Women having OAPS-only and women with OM related to antiphospholipid antibodies (aPL) but not fulfilling APS classification criteria (OMAPS), may show similar patterns. AIM: The aim of this research was to collect records of OAPS and OMAPS cases in order to have valuable information about their clinical features, laboratory, treatment, pregnancy outcomes and long-term follow-up. METHODS: EUROAPS/EUROMAPS is a registry in the frame of the European Forum on Antiphospholipid Antibody projects. Its own website has been available since June 2010: www.euroaps.org. RESULTS: This registry comprises 211 women including 304 pre-enrolment pregnancies, and 226 prospective cases, 194 of OAPS and 32 of OMAPS. OM was more frequent in OAPS than in OMAPS, independent of treatment. In the prospective cohort, standard aPL data was available in 202 cases and treatment data in all 226 cases. Good fetal outcomes were obtained when low dose aspirin plus low molecular weight heparin were administered. Prevalence of thrombotic events and/or cases evolving into full-blown systemic lupus erythematosus (SLE) was low. CONCLUSIONS: OAPS could be a different form of APS. OMAPS/OMAPS fetal outcomes were better when treated. The prevalence of thrombosis and progression to SLE were lower than in 'classical' APS.

Prevalence and clinical usefulness of antiphospholipid and anticofactor antibodies in different Spanish preeclampsia subsets.

OBJECTIVE: To study the prevalence and clinical usefulness of antiphospholipid antibodies in different preeclampsia subsets. DESIGN: Observational cross-sectional study. SETTING: Tertiary teaching hospital. PATIENTS: Ninety-nine women with preeclampsia versus 83 healthy pregnant women as controls. INTERVENTIONS: We analysed anticardiolipin IgG/IgM, anti-ß(2)glycoprotein IgG/IgM, antiphosphatidylserine IgG/IgM, antiAnnexin-A5 IgG/IgM, and lupus anticoagulant. MAIN OUTCOME MEASURE: Comparison of antiphospholipid antibody positivity between groups. RESULTS: Antiphospholipid antibody prevalence was 14.14% in the study group vs. 7.23% in controls. Excluding antiAnnexin-A5-positive women, overall antiphospholipid prevalence was 13.19% vs. 3.61% (p = 0.034). Only IgM-anticardiolipin positivity showed significant differences between preeclampsia group and controls (8.1% vs. 1.20%, p = 0.041). Comparing a severe preeclampsia subset vs. controls, we obtained these significant results: for two or more positive antiphospholipid tests: 9.09% vs. 1.20 (p = 0.037); IgM-anticardiolipin 10.91% vs. 1.20% (p = 0.016); IgG/IgM-anti-ß(2)glycoprotein-I 10.91% vs. 1.90% (p = 0.016), IgM-anti-ß(2)glycoprotein-I 9.09% vs.1.20 (p = 0.037). When comparing early-onset preeclampsia vs. controls we found IgM-anticardiolipin 11.11% vs. 1.20% (p = 0.029). CONCLUSIONS: Prevalence of antiphospholipid antibodies in preeclampsia patients is twice that in healthy pregnant women. Multipositive aPL test, IgM-anticardiolipin and IgM-anti-ß(2)glycoprotein-I isotypes showed an association with severe and early-onset preeclampsia. Larger studies are needed to establish the usefulness of antiphospholipid tests as risk markers for severe and early onset preeclampsia.

Obstetric antiphospholipid syndrome.

Obstetric antiphospholipid syndrome is an acquired autoimmune disorder that is associated with various obstetric complications and, in the absence of prior history of thrombosis, with the presence of antiphospholipid antibodies directed against other phospholipids, proteins called cofactors or PL-cofactor complexes. Although the obstetric complications have been related to the procoagulant properties of antiphospholipid antibodies, pathological studies of human placenta have shown the proinflammatory capacity of antiphospholipid antibodies via the complement system and proinflammatory cytokines. There is no general agreement on which antiphospholipid antibodies profile (laboratory) confers the greatest obstetric risk, but the best candidates are categories I and IIa. Combined treatment with low doses of aspirin and heparin achieves good obstetric and maternal outcomes. In this study, we also review the therapeutic possibilities in refractory cases, although the likelihood of progressing to other autoimmune diseases is low. We briefly comment on incomplete obstetric antiphospholipid syndrome, also known as antiphospholipid antibody-mediated pregnancy morbidity syndrome.