POS0682 RETROSPECTIVE ANALYSIS OF PREGNANCY OUTCOMES IN PATIENTS WITH OBSTETRIC ANTIPHOSPHOLIPID SYNDROME (OAPS), NON-CRITERIA OAPS (NC-OAPS) AND ANTIPHOSPHOLIPID CARRIERS
Authors: M. E. D’amico, M. S. Ciliento, P. Melissa, M. Govoni
Journal: Annals of the Rheumatic Diseases (2021)

Background: Antiphospholipid (aPL) antibodies are considered in obstetric morbidity even when Sydney criteria for OAPS are not met. Classification and treatment of NC-OAPS patients and aPL carriers during pregnancy are still debated. Objectives: To increase knowledge, we evaluated and compared aPL serum profiles, exposure to antithrombotic therapies and pregnancy outcomes in OAPS, NC-OAPS and aPL carrier patients, accessing to our centre. Methods: A retrospective observational study was conducted on pregnant outpatients from January 2003 to April 2020. According to Sydney revised classification criteria, we considered lupus anticoagulant (LA), IgM and IgG anti-cardiolipin antibodies (aCL), IgM and IgG antibeta2 glycoprotein I antibodies (aβ2-GPI), to stratify aPL risk profiles [Ref]. In each pregnancy, after case stratification into high (≥ 2 aPL or LA serum positivity) versus low (single aPL positivity) risk profile, we evaluated antithrombotic treatment strategy and subsequent pregnancy outcomes as live-births, spontaneous abortions (SA) or foetal losses. Results: A total of 78 pregnancies were followed: 17 in OAPS, 9 in NC-OAPS and 52 in aPL carrier patients. Rheumatic diseases (RD) coexisted predominately in carriers (73.1%), mainly systemic lupus erythematosus (57.9%). As presented in Table 1, in OAPS and aPL plus RD carrier groups the association of acetyl-salicylic acid (ASA - mean dose 100 mg q.d.) and low-molecular weight heparin (LMWH - mean dose 4000 UI q.d.) showed a better rate of positive outcomes (97.8% of pregnancies) in high aPL risk profile, compared to monotherapy, especially with LA or triple aPL positivity. Conversely, negative outcomes occurred mostly with triple aPL positivity in the first group and double aPL in the second, despite therapy approaches. No significant data were obtained in NC-OAPS group, due to its paucity, though adverse outcomes were observed with monotherapy both in high and low risk profiles. Except aPL carriers with RD, in all other low risk subgroups, a prevalence of negative outcomes occurred using ASA alone, without statistical significance (OR 0; p= 0.45). Similarly, considering the whole population, the use of a mono or a combination therapy in high risk subgroups had not a significant correlation with pregnancy outcomes (OR 1.79; 95%CI 0.31-10.15; p= 0.50). Conclusion: In our study, negative pregnancy outcomes were sporadic, occurring mostly with ≥ 2 aPL positivity. Combination treatment showed better results overall in high aPL risk profile patients, both in OAPS and NC-OAPS or aPL carriers. Though no significant correlation between outcomes and treatments were found, we hinted how aPL-based risk stratification may be useful in adopting personalised therapies to prevent obstetric failures. Reference: [1]Miyakis S, et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome. J Thromb Haemost 4:295–306. Table 1. Population groups, aPL risk profiles, antithrombotic therapies and pregnancy outcomes. Population group aPL risk profile Type/n° of aPL Therapy (n° of pregnancies ) Pregnancy outcomes OAPS High LA ASA (1) ASA + LMWH (1) 1 live-birth 1 live-birth 2 aPL ASA + LMWH (3) 3 live-births 3 aPL ASA + LMWH (9) 7 live-births 2 foetal losses Low 1 aPL ASA (2) ASA + LMWH (1) 1 live-birth 1 foetal loss 1 live-birth NC-OAPS High LA - - 2 aPL ASA (1) LMWH (1) 1 live-birth 1 SA 3 aPL - - Low 1 aPL ASA (6) ASA + LMWH (1) 5 live-births 1 SA 1 live-birth aPL carriers without RD High LA ASA (1) LMWH (1) 1 live-birth 1 live-birth 2 aPL ASA (1) LMWH (2) 1 live-birth 2 live-births 3 aPL ASA (1) ASA + LMWH (3) 1 live-birth 3 live-births Low 1 aPL ASA (5) 4 live-births 1 foetal loss aPL carriers with RD High LA ASA (4) ASA + LMWH (7) 3 live-birth 1 foetal loss 6 live-births 1 SA 2 aPL ASA (6) ASA + LMWH (4) 6 live-births 2 live-births 1 SA 1 foetal loss 3 aPL LMWH (2) ASA + LMWH (5) 2 live-births 5 live-births Low 1 aPL ASA (8) ASA + LMWH (3) 8 live-births 3 live-births Disclosure of Interests: None declared