THU0275 SEVERE PREECLAMPSIA RELATED TO ANTIPHOSPHOLIPID SYNDROME: AN EUROPEAN STUDY OF 40 WOMEN
Authors: M. Larosa, N. Morel, M. Belhocine, A. Ruffatti, N. M. Silva, R. Paul, L. Mouthon, M. Dreyfus, J. C. Piette, O. Souchaud-Debouverie, C. Deneux-Tharaux, V. Tsatsaris, E. Pannier, G. Guettrot Imbert, V. Le Guern, A. Doria, N. Costedoat-Chalumeau
Journal: Annals of the Rheumatic Diseases (2020)

Background: One of the 3 features of obstetrical antiphospholipid syndrome (APS) is severe preeclampsia (PE). Its time of occurrence, the associated risk of thromboses and systemic lupus erythematosus (SLE) have not been reported yet. Objectives: We analyzed severe PE in a series of women with APS. Methods: We retrospectively collected data of female patients from 5 French internal medicine and 1 Italian rheumatology units. Inclusion criteria were: a severe PE/eclampsia(1), that occurred before 34 weeks of gestation (WG) in patients who met the APS classification criteria(2). Results: 40 patients were enrolled (Table 1). Because of known APS/positive aPL/previous obstetrical complications, 23(57.5%) patients were treated during the index PE: 4 with low dose aspirin (LDA), 4 with low molecular weight heparin (LMWH), and 15 with a combination of both. 7 patients were also treated with hydroxychloroquine, 8 with corticosteroids and 3 with immunosuppressants. 17(42.5%) patients received no treatment. 24(60%) live births were observed. During a follow-up period of 3 years, 26(65%) patients had at least 1 new pregnancy, with a total of 38 pregnancies which resulted in 33(86.8%) live births. 57.5% pregnancies who resulted in live births occurred without any maternal or fetal complications. All 26 patients who had at least 1 pregnancy after index PE were treated with LDA; LMWH was given at prophylactic and therapeutic dosage in 13(50%) patients, respectively. No patient experienced 3 consecutive miscarriages. Table 1. 40 APS patients with severe PE Overall features (n, %) Patients 40 (100) Age at PE, (median, IQR) 30.5 (27-33) PE term, WG (median, IQR) 25.5 (23-29) Live births 24 (60) Birth term, WG (median, IQR) 25.5 (23.7-30.3) Associated SLE 12 (30) Maternal complications (n, %) 25 (62.5) HELLP 18 (45) E 6 (15) CAPS 3 (7.5) Placental abruptions 3 (7.5) Fetal complications (n, %) 31 (77.5) IUGR 18 (45) IUFD 11 (2.5) Preterm delivery 22 (55) Obstetrical history (n, %) Primiparous 21 (52.5) Index PE before APS 12 (30) Thrombosis (n, %) Thrombosis before PE index 14 (35.0) Thrombosis after PE index 2 (5.0) Abs at APS diagnosis (n, %) aPL triple positivity 21 (52.5) IgG/IgM anti-cardiolipin 34 (85.0) IgG/IgM anti-β2GPI 25 (62.5) LAC 33 (82.5) Legend to Table 1: PE: preeclampsia; APS: antiphospholipid syndrome; IQR: interquartile range; WG: weeks of gestation; SLE: systemic lupus erythematosus; HELLP: Hemolysis, elevated liver enzymes, low platelet; E: eclampsia; CAPS: catastrophic APS; IUGR: intrauterine growth restriction; IUFD: intrauterine fetal death; CHB: congenital atrioventricular block; aPL: antiphospholipid antibodies; LAC: lupus anticoagulant. Conclusion: Among the APS criteria, “3 consecutive miscarriages criterion” was not found. The majority of patients also experienced thrombosis and SLE before the index PE. References: [1]Diagnosis and Management of preeclampsia and eclampsia. International Journal of Gynecology &amp;Obestetrics 2002;77:67-75. [2]Miyakis S, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295e 306. Disclosure of Interests: Maddalena Larosa: None declared, Nathalie Morel: None declared, Meriem BELHOCINE: None declared, Amelia Ruffatti: None declared, Nicolas Martin Silva: None declared, Romain Paul: None declared, Luc Mouthon: None declared, Michel DREYFUS: None declared, Jean-Charles PIETTE: None declared, Odile Souchaud-Debouverie: None declared, Catherine Deneux-Tharaux: None declared, Vassilis Tsatsaris: None declared, Emmanuelle Pannier: None declared, Gaêlle Guettrot Imbert: None declared, Véronique LE GUERN Grant/research support from: UCB for GR2 study (to our institution), Andrea Doria Consultant of: GSK, Pfizer, Abbvie, Novartis, Ely Lilly, Speakers bureau: UCB pharma, GSK, Pfizer, Janssen, Abbvie, Novartis, Ely Lilly, BMS, Nathalie Costedoat-Chalumeau Grant/research support from: UCB to my institution