The association of antiphospholipid antibodies with intrauterine fetal death: a case-control study |
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Authors: | Helgadottir Linda Björk Skjeldestad Finn Egil Jacobsen Anne Flem Sandset Per Morten Jacobsen Eva-Marie |
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Affiliation: | a Department of Haematology, Oslo University Hospital Ullevål, Oslo, Norwayb Department of Obstetrics and Gynaecology, Oslo University Hospital Ullevål, Oslo, Norwayc Institute of Clinical Medicine, University of Oslo, Oslo, Norwayd Department of Gynaecology and Obstetrics, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway |
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Abstract: | IntroductionOver the past few decades it has been recognized that antiphospholipid antibodies are associated with pregnancy loss. Other placenta-mediated pregnancy complications have also been associated with the presence of antiphospholipid antibodies. Most studies have measured antiphospholipid antibodies near the time of the event investigated.ObjectivesTo investigate the association of antiphospholipid antibodies and a history of intrauterine fetal death (IUFD) in a case-control design.Materials and methodsA case-control study of 105 women with a history of IUFD after 22 gestational weeks and 262 controls with live births. The prevalence of lupus anticoagulant, anticardiolipin- and anti-β2-glycoprotein 1 antibodies were measured 3-18 years after the event of IUFD.ResultsTotal 9.5% of women with a history of IUFD and 5.0% of controls had at least one positive test for antiphospholipid antibodies (OR 2.0; 95% confidence interval (CI) 0.9-4.8). Women with a history of IUFD were significantly more often positive for lupus anticoagulant compared to controls (OR 4.3; 95% CI 1.0-18.4). The association of lupus anticoagulant with a history of IUFD was confined to women positive for other antiphospholipid antibodies in addition to lupus anticoagulant. Being positive for anti-β2-glycoprotein 1 or anticardiolipin antibodies alone was not significantly associated with a history of IUFD.ConclusionsWomen with a history of IUFD after 22 gestational weeks were more often lupus anticoagulant positive. The association was confined to women with multiple positivity for antiphospholipid antibodies, although firm conclusions on the importance of multiple positivity cannot be made from this study. |
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Keywords: | APAs, antiphospholipid antibodies PMPC, placenta mediated pregnancy complications aCL, anticardiolipin antibodies IgG, immunoglobulin G isotype LA, lupus anticoagulant IUFD, intrauterine fetal death VIP, the Venous Thromboembolism In Pregnancy study anti-β2GP1, anti-β2-glycoprotein 1 antibodies LR, lupus ratio APTT, activated partial thromboplastin time RVVT, Russell viper venom time IgM, immunoglobulin M isotype ELISA, enzyme-linked immunosorbent assay OR, odds ratio CI, confidence interval ACCP, American College of Chest Physicians |
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