AB0457 OBSTETRICAL OUTCOME AND TREATMENTS DURING PREGNANCY IN SERONEGATIVE PRIMARY APS: DATA FROM EUROPEAN RETROSPECTIVE STUDY
Authors: N. Abisror, Y. Nguyen, L. Marozio, E. Esteve-Valverde, S. Udry, D. E. Pleguezuelo, P. Billoir, K. Mayer-Pickel, G. Urbanski, P. Zigon, C. De Moreuil, A. Hoxha, H. Bezanahary, L. Carbillon, G. Kayem, M. Bornes, C. Yelnik, C. Johanet, P. Nicaise Roland, M. Lambert, V. Salle, O. Latino, E. Hachlla, C. Benedetto, Y. Benhamou, J. Alijotas-Reig, O. Fain, A. Mekinian
Journal: Annals of the Rheumatic Diseases (2020)

Background: Objectives: To compare clinical characteristics, pregnancies, and treatments during pregnancies of seronegative and seropositive APS, and analyse factors associated with adverse obstetrical outcomes. Methods: Inclusion criteria were: (1) thrombotic arterial and/or venous; and /or obstetrical primary clinical APS (Sydney criteria); (2) absence of conventional antiphospholipid antibodies; (3) presence of at least one non-conventional APL among IgA ACL, IgA antiB2GPI, anti-vimentin G/M, anti-annexin V G/M, anti-PE G/M, anti-PS/PT G/M antibodies. The exclusion criteria were: (1) seropositive APS with conventional APS; (2) associated SLE or SLE like (SLE features and / or positive antinuclear autoantibodies); (3) other systemic connective tissue disease (Sjogren’s syndrome, systemic sclerosis, myositis). Results: 187 women (mean 33±5 years) with seronegative APS were included from 12 centers in the world and compared to 285 patients with seropositive APS. Seronegative APS have mostly obstetrical phenotypes rather than venous thrombosis in comparison to seropositive APS. The maternal and fetal outcomes and the rates of live births were not significantly different in seronegative and seropositive APS, except for higher rates of intrauterine deaths (15% vs 5%; p=0.03) and lower live birth term (36±3 vs 38±3 weeks of gestation; p=0.04) in the seropositive APS group. The cumulative incidence of adverse obstetrical events was significantly improved in treated seronegative APS vs untreated ones (log rank&lt;0.05), whereas there was no difference between patients who received aspirin or aspirin-LMWH combination Conclusion: Patients with clinical manifestations of APS without conventional APL should undergo testing for non-criteria APL. The diagnosis of seronegative APS could be important for a better care of these patients. Table 1. Characteristics of seronegative and seropositive APS women. Seronegative APS N=187 Seropositive APS N=285 APS features Thrombotic APS Arterial APS (n;% ) 0 105 (37)* Venous APS (n;% ) 9 (6) 154 (54)* Obstetrical APS (n;% ) 168 (89) 89 (31)* Mix APS (n;% ) 8 (4) 16 (6) Non criteria features (n;% ) 16 (9) 141 (49)* Obstetrical history Miscarriages (n;% ) 66 (35) 18 (6)* Intrauterine deaths (n;% ) 60 (32) 46 (16)* Prematurity &lt;34 wg (n;% ) 43 (23) 31 (11)* Table 2. Pregnancy outcome and treatment in seronegative and seropositive APS. Seronegative APS pregnancies N=108 Seropositive APS pregnancies N=75 Thrombotic APS Arterial APS (n;% ) 0 20 (27)* Venous APS (n;% ) 8 (7) 42 (56)* Obstetrical APS (n;% ) 93 (86) 36 (48)* Mix APS (n;% ) 6 (6) 18 (24) Aspirin (n;%) / Aspirin alone 95 (88) / 32 (30) 57 (76)* / 2 (3)* LMWH isocoagulant amounts (n;% ) 63 (58) 39 (52) Aspirin-LMWH (n;% ) 65 (60) 55 (73) Preeclampsia/HELLP syndrome (n;% ) 7 (7) 12 (16)* IUGR (n;% ) 5 (5) 7 (10) Fetal loss (n;% ) 33 (31) 22 (29) Miscarriage / Intrauterine deaths 23 (21) / 5 (5) 11 (15) / 11 (15)* Prematurity&lt;34 weeks of gestation (n;% ) 6 (6) 9 (12) Term of fetal loss (weeks gestation ) 10±8 13±7 Live births (n;% ) 75 (69) 53 (70) Term of live birth (weeks gestation ) 38±3 36±3* Disclosure of Interests: : None declared