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Blood, 15 November 2003, Vol. 102, No. 10, pp. 3504-3513.
Prepublished online as a Blood First Edition Paper on July 17, 2003; DOI 10.1182/blood-2003-01-0320.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Antiphospholipid/antiprotein antibodies, hemostasis-related autoantibodies, and plasma homocysteine as risk factors for a first early pregnancy loss: a matched case-control study
Jean-Christophe Gris,
Thomas V. Perneger,
Isabelle Quéré,
Eric Mercier,
Pascale Fabbro-Peray,
Géraldine Lavigne-Lissalde,
Médéric Hoffet,
Hervé Déchaud,
Jean-Christophe Boyer,
Sylvie Ripart-Neveu,
Marie-Laure Tailland,
Jean-Pierre Daurès,
Pierre Marès, and
Michel Dauzat
From the Haematology Laboratory, University Hospital, Nîmes, France; the Department of Medical Information, University Hospital, Nîmes, France; the Department of Gynaecology and Obstetrics, University Hospital, Nîmes, France; the Equipe d'Accueil 2992, Montpellier 1 University, Montpellier, France; the Quality of Care Unit, Geneva University Hospitals, Geneva, Switzerland.
Maternal hypercoagulability is a possible cause of miscarriage during the eighth and ninth weeks of pregnancy, when the placenta replaces the yolk sac. We thus examined associations between putative markers of an acquired hypercoagulable state and the risk of first miscarriage. We conducted a case-control study comparing 743 women who miscarried in weeks 8 and 9 with 743 women who underwent a first provoked abortion, matched for age, number of pregnancies, and time elapsed since abortion. Levels of plasma homocysteine and of various antiphospholipid/antiprotein and hemostasis-related autoantibodies were categorized in 4 strata (percentiles 1-80, 81-95, 96-99, 100 among control patients) and analyzed in conditional logistic regression models. Pregnancy loss was independently associated with positive lupus anticoagulant (matched odds ratio [OR], 2.6; 95% confidence interval [CI], 1.1-6.0), high levels of immunoglobulin M (IgM) antibodies against cardiolipin (OR for percentile 100 versus 0-80, 3.5; CI, 1.2-10.1) and against phosphatidylethanolamine (OR, 4.7; CI, 1.9-12.1), high levels of IgG antibodies against annexin V (OR, 3.2; CI, 1.1-9.1) and against tissue-type plasminogen activator (OR, 19.5; CI, 7.9-48.0), and high homocystinemia (OR, 4.1; CI, 1.3-12.5). A first early pregnancy loss is associated with increased levels of several autoantibodies and of homocysteine. (Blood. 2003;102:3504-3513)
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