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Relationship of antiphospholipid antibodies to pregnancy loss in patients
with systemic lupus erythematosus: a cross-sectional study [see comments]
JS Ginsberg, P Brill-Edwards, M Johnston, JA Denburg, M Andrew, RF Burrows, W Bensen, A Cividino and AA Long
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
To determine whether an association exists between the presence of
antiphospholipid antibodies and pregnancy loss, a cross-sectional study was
performed. Consecutive women who were referred to three outpatient
rheumatology clinics and who had systemic lupus erythematosus (SLE) and a
history of one or more pregnancies were evaluated. Patients were
interviewed to determine outcomes of all previous pregnancies. Blood was
taken on two separate occasions at least 3 months apart to test for the
presence of the lupus anticoagulant and anticardiolipin antibodies; on both
occasions, five tests of the lupus anticoagulant, with well- defined normal
ranges, and an enzyme-linked immunosorbent assay to measure IgG
anticardiolipin antibodies were performed. Patients were considered to be
positive for the lupus anticoagulant if one or more tests was abnormal on
both occasions and positive for anticardiolipin antibodies if the test was
abnormal on both occasions. Forty-two women were studied. Statistically
significant associations were shown between lupus anticoagulant positivity
and previous pregnancy loss (odds ratio [OR], 4.8; 95% confidence intervals
[CI], 1.0 to 23.6; P = .05) and between anticardiolipin antibody positivity
and previous pregnancy loss (OR, 20.0; 95% CI, 1.3 to 97.0; P = .01). All
seven women with multiple episodes of pregnancy loss were lupus
anticoagulant positive and four of these were also anticardiolipin antibody
positive. If patients who are transiently positive for lupus anticoagulant
and/or anticardiolipin antibodies are considered to be test positive, the
associations with pregnancy loss are no longer statistically significant.
Within the group of lupus anticoagulant-positive patients, we observed
stronger associations between the presence of six or more positive tests
and pregnancy loss than between the presence of two to five positive tests
and pregnancy loss. No single test for the lupus anticoagulant provides a
statistically significant association with pregnancy loss. The results of
our study show that by performing multiple lupus anticoagulant tests and by
repeating testing for lupus anticoagulant and anticardiolipin antibodies on
more than one occasion, significant associations between the presence of
antiphospholipid antibodies and previous pregnancy loss can be shown in
patients with SLE.
Volume 80,
Issue 4,
pp. 975-980,
08/15/1992
Copyright © 1992 by The American Society of Hematology
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