Outcomes of pregnancies in women with suspected antiphospholipid syndrome

Article type: Research Article

Authors: Nili, F. | McLeod, L. | O'Connell, C. | Sutton, E. | McMillan, D.

Affiliations: Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran | Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada | Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, NS, Canada | Department of Internal Medicine, Dalhousie University, Halifax, NS, Canada | Department of Pediatrics, Dalhousie University, Halifax, NS, Canada

Note: [] Corresponding author: Dr. Douglas McMillan, Division of Neonatal-Perinatal Medicine, 5850/5980 University Avenue, IWK Health Centre, P.O. Box 9700, Halifax, NS B3K 6R8, Canada. Tel.: +1 902 470 8803; Fax: +1 902 470 6469; E-mail: doug.mcmillan@dal.ca

Abstract: OBJECTIVES: To evaluate maternal and neonatal outcomes in women suspected to have primary antiphospholipid syndrome (PAPS). METHODS: A cohort from the Nova Scotia Atlee Perinatal Database (n = 211034) was studied. A total of 58 women with antiphospholipid antibodies without a clinical diagnosis of rheumatologic disease were evaluated. We compared them to maternal and neonatal outcomes of women without rheumatologic disease or PAPS who delivered in Nova Scotia 1988–2008. RESULTS: With PAPS, mean maternal age was older; mean gestational age and mean neonatal birth weight were less. With bivariate analysis, maternal colonization and urinary tract infection with group B streptococcus, thromboembolic disease, thrombocytopenia and Caesarean birth were more frequent in the suspected PAPS group compared to the control. Among neonates, hyperbilirubinemia, anemia, apnea, intraventricular hemorrhage grade I and II, retinopathy of prematurity, bronchopulmonary dysplasia, neonatal intensive care unit admission, and assisted ventilation occurred more frequently with PAPS. Babies in PAPS group had a longer hospital stay (8.7 vs 3.9 days). Logistic regression analysis identified that PAPS was only associated with increased risks of preeclampsia (Odds Ratio (OR) 2.2; 95% Confidence Interval (CI) 1.1–4.3; P = 0.016), urinary tract infection (OR 2.2; 95% CI 1.1–4.6; P = 0.02), and prematurity (gestational age ≤37) (OR 2.2; 95% CI, 1.07–4.3, P = 0.03). Positive predictive values for pregnancy induced hypertension, urinary tract infection and prematurity in women who had suspected APS were 24.1%, 17.2% and 45.6% respectively. CONCLUSION: With suspected PAPS, risks for preeclampsia, urinary tract infection and prematurity are increased. Outcomes for babies are related to prematurity.

Keywords: Antiphospholipid antibodies, antiphospholipid syndrome, pregnancy, newborn, outcome

DOI: 10.3233/NPM-1370113

Journal: Journal of Neonatal-Perinatal Medicine, vol. 6, no. 3, pp. 225-230, 2013