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Prepublished online as a Blood First Edition Paper on July 17, 2003; DOI 10.1182/blood-2003-01-0320.

Submitted February 3, 2003
Accepted July 7, 2003
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 Quere, Eric Mercier, Pascale Fabbro-Peray, Geraldine Lavigne-Lissalde, Mederic Hoffet, Herve Dechaud, Jean-Christophe Boyer, Sylvie Ripart-Neveu, Marie-Laure Tailland, Jean-Pierre Daures, Pierre Mares, and Michel Dauzat
Haematology Laboratory, University Hospital, Nimes, France; Montpellier 1 University, Nimes, France
Department of Medical Information, University Hospital, Nimes, France
Department of Gynaecology and Obstetrics, University Hospital, Nimes, France
Quality of Care Unit, Geneva University Hospitals, Geneva, Switzerland
* Corresponding author; email: jcgris{at}chu-nimes.fr.
Maternal hypercoagulability is a possible cause of miscarriage during the 8th and 9th week 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 four strata (percentiles 1-80, 81-95, 96-99, 100 among controls) 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 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 homocysteinaemia (OR 4.1, CI 1.3-12.5). A first early pregnancy loss is associated with increased levels of several autoantibodies and of homocysteine.

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