Email this article Prevention of pregnancy loss in women with circulation of non-conventional antiphospholipid autoantibodies
- Authors: Kornyushina E.A.1, Chepanov S.V.1, Selkov S.A.1, Dadayeva D.G.1, Shakhaliyev R.A.2, Chudotvorov K.N.3, Nemstsveridze N.N.2
-
Affiliations:
- Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott
- Saint Petersburg State Pediatric Medical University
- Academician I.P. Pavlov First Saint Petersburg State Medical University
- Issue: Vol 67, No 6 (2018)
- Pages: 24-30
- Section: Articles
- URL: https://journals.rcsi.science/jowd/article/view/10966
- DOI: https://doi.org/10.17816/JOWD67624-30
- ID: 10966
Cite item
Full Text
Abstract
Hypothesis/aims of study. Patients with a history of pregnancy complications that meet the clinical criteria of antiphospholipid syndrome (APS), with circulation of autoantibodies not related to the laboratory criteria for APS, present difficulties in choosing a method for preventing recurrent complications. The aim of this study was to determine the frequency of autoantibodies in women with severe obstetric complications and habitual miscarriage and to evaluate the effectiveness of therapy used in APS for the prevention of recurrent reproductive losses in women with non-criteria autoantibodies.
Study design, materials and methods. 358 women with a history of APS clinical criteria or two pregnancy losses up to 10 weeks were examined. Anti-beta2-glycoprotein I and anti-cardiolipin (IgG/IgM) antibodies, as well as non-conventional autoantibodies for phosphatidylinositol, phosphatidylserine, phosphatidyl acid, annexin V, and prothrombin were determined in serum, with lupus anticoagulant test performed. In 39 women with clinical criteria for APS and circulating anti-annexin V or prothrombin antibodies during pregnancy, enoxaparin sodium was used (in 100% of the cases) in combination with acetylsalicylic acid (ASA) at a dose of 50-100 mg per day (in 69.2% of the cases).
Results. The frequency of all types of autoantibodies was 38.8%. Non-conventional antibodies were detected in 17.6% of the cases (isolated circulation in 11.5% of the cases); with anti-annexin V antibodies (73.0%) prevailed among them. In 39 patients with non-criteria antibodies, after the use of a prophylactic dose of enoxaparin sodium and ASA, live births were the outcome of pregnancy in 84.6% of the cases.
Conclusion. Testing for non-conventional autoantibodies may be appropriate in patients with only APS clinical criteria. Standard treatment of APS prescribed for this group of patients led to a significant increase in the frequency of live births. Further large studies are needed to evaluate the efficacy of medical prophylaxis of adverse pregnancy outcomes in women with non-criteria obstetric ABS.
Full Text
##article.viewOnOriginalSite##About the authors
Ekaterina A. Kornyushina
Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott
Author for correspondence.
Email: hapacheva@yandex.ru
MD, PhD, Senior Researcher. The Department of Pathology of Pregnancy No. 2
Russian Federation, Saint PetersburgSergey V. Chepanov
Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott
Email: chepanovsv@gmail.com
MD, PhD
Russian Federation, Saint PetersburgSergey A. Selkov
Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott
Email: selkovsa@mail.ru
MD, PhD, DSci (Medicine), Professor, Honoured Scholar of the Russian Federation, the Head of the Department of Immunology and Intercellular Interactions
Russian Federation, Saint PetersburgDzhamilya G. Dadayeva
Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott
Email: djamilya2010@mail.ru
MD, Post-Graduate Student
Russian Federation, Saint PetersburgRustam A. Shakhaliyev
Saint Petersburg State Pediatric Medical University
Email: rustam.shahaliev@gmail.com
Student, Pediatric Faculty
Russian Federation, Saint PetersburgKirill N. Chudotvorov
Academician I.P. Pavlov First Saint Petersburg State Medical University
Email: chudotvorovkn@gmail.com
Student, Medical Faculty
Russian Federation, Saint PetersburgNadezhda N. Nemstsveridze
Saint Petersburg State Pediatric Medical University
Email: hope1704@mail.ru
Student, Pediatric Faculty
Russian Federation, Saint PetersburgReferences
- Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4(2):295-306. doi: 10.1111/j.1538-7836.2006.01753.x.
- Hughes GR. Thrombosis, abortion, cerebral disease, and the lupus anticoagulant. Br Med J (Clin Res Ed). 1983;287(6399):1088-1089.
- Hughes GR, Khamashta MA. Seronegative antiphospholipid syndrome. Ann Rheum Dis. 2003;62(12):1127. doi: 10.1136/ard.2003.006163.
- Gris JC, Quere I, Sanmarco M, et al. Antiphospholipid and antiprotein syndromes in non-thrombotic, non-autoimmune women with unexplained recurrent primary early foetal loss. The Nimes Obstetricians and Haematologists Study - NOHA. Thromb Haemost. 2000;84(2):228-236. doi: 10.1055/s-0037-1614001.
- Matsubayashi H, Arai T, Izumi S, et al. Anti-annexin V antibodies in patients with early pregnancy loss or implantation failures. Fertil Steri. 2001;76(4):694-649. doi: 10.1016/S0015-0282(01)02009-X.
- Чепанов С.В., Шляхтенко Т.Н., Зайнулина М.С., и др. Антитела к аннексину V у женщин с привычным невынашиванием беременности // Акушерство и гинекология. - 2014. - № 7. - С. 29-32. [Chepanov SV, Shlyakhtenko TN, Zaynulina MS, et al. Anti-annexin V antibodies in women with recurrent miscarriage. Akush Ginekol (Mosk). 2014;(7):29-32. (In Russ.)]
- Гончарова А.А., Кравченко Е.Н., Кривчик Г.В., и др. Антифосфолипидный синдром в акушерской практике // Мать и дитя в Кузбассе. - 2018. - № 1. - С. 52-56. [Goncharova AA, Kravchenko EN, Krivchik GV, et al. Antiphospholipid syndrome in objective practice. Mat’ i ditya v Kuzbasse. 2018;(1):52-56. (In Russ).]
- Кривонос М.И., Зайнулина М.С., Корнюшина Е.А., и др. Опыт применения внутривенного иммуноглобулина в протоколе ЭКО (ЭКО/ICSI) у женщин с бесплодием и носительством антифосфолипидных антител // Акушерство, гинекология и репродукция. - 2017. - Т. 11. - № 3. - С. 11-19. [Krivonos MI, Zaynulina MS, Kornyushina EA, et al. Use of intravenous immunoglobulin within the IVF/ICSI protocol in women with infertility and antiphospholipid antibodies. Obstetrics, Gynecology and Reproduction. 2017;11(3):11-19. (In Russ.)]. doi: 10.17749/2313-7347.2017.11.3.011-019.
- Karata S, Aydin Y, Ocer F, et al. Hereditary thrombophilia, anti-beta2 glycoprotein 1 IgM, and anti-annexin V antibodies in recurrent pregnancy loss. Am J Reprod Immunol. 2012;67(3):251-255. doi: 10.1111/j.1600-0897.2011.01092.x.
- Bizzaro N, Antico A, Musso M, et al. A prospective study of 1038 pregnancies on the predictive value of anti-annexin V antibodies for fetal loss. Ann N Y Acad Sci. 2005;1050:348-356. doi: 10.1196/annals.1313.037.
- Alijotas-Reig J, Ferrer-Oliveras R, Rodrigo-Anoro MJ, et al. Anti-annexin A5 antibodies in women with spontaneous pregnancy loss. Med Clin (Barc). 2010;134(10):433-438. doi: 10.1016/j.medcli.2009.09.040.
- Committee on Practice Bulletins-Obstetrics ACoO, Gynecologists. Practice Bulletin No. 132: Antiphospholipid syndrome. Obstet Gynecol. 2012;120(6):1514-1521. doi: 10.1097/01.AOG.0000423816.39542.0f.
- Tebo AE, Jaskowski TD, Phansalkar AR, et al. Diagnostic performance of phospholipid-specific assays for the evaluation of antiphospholipid syndrome. Am J Clin Pathol. 2008;129(6):870-875. doi: 10.1309/6MPULFBL24FM9B50.
- Приказ Министерства здравоохранения РФ № 572н от 12 ноября 2012 г. «Об утверждении Порядка оказания медицинской помощи по профилю „акушерство и гинекология (за исключением использования вспомогательных репродуктивных технологий)“». [Order of the Ministry of Health of the Russian Federation No. 572n of 12 Nov 2012. “Ob utverzhdenii Poryadka okazaniya meditsinskoy pomoshchi po profilyu ʽakusherstvo i ginekologiya (za isklyucheniem ispol’zovaniya vspomogatel’nykh reproduktivnykh tekhnologiy)ʼ ˮ. (In Russ.)]
- Mekinian A, Bourrienne MC, Carbillon L, et al. Non-conventional antiphospholipid antibodies in patients with clinical obstetrical APS: Prevalence and treatment efficacy in pregnancies. Semin Arthritis Rheum. 2016;46(2):232-237. doi: 10.1016/j.semarthrit.2016.05.006.
Supplementary files
