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Elevated antiphospholipid antibody titers and adverse pregnancy outcomes: analysis of a population-based hospital
James Nodler1, Surjit R Moolamalla, Elizabeth M Ledger
1Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama, USA. jnodler@uab.edu
Insights
Elevated antiphospholipid antibodies are linked to higher risks of preeclampsia, placental insufficiency, and prolonged hospital stays in pregnant women. Systemic lupus erythematosus (SLE) further increases these risks.
Area of Science:
- Obstetrics and Gynecology
- Immunology
- Epidemiology
Background:
- Antiphospholipid antibodies (aPL) are associated with various adverse pregnancy outcomes.
- Understanding the prevalence and impact of aPL in a diverse population is crucial for maternal health.
- Previous studies have suggested links between aPL and conditions like preeclampsia and placental insufficiency.
Purpose of the Study:
- To investigate the association between elevated antiphospholipid antibody titers and key obstetric complications.
- To determine if systemic lupus erythematosus (SLE) modifies the relationship between aPL and adverse outcomes.
- To analyze these associations in a large cohort of women delivering in Florida.
Main Methods:
- Cross-sectional analysis of a statewide hospital database from Florida in 2001.
- Prevalence odds ratios (OR) calculated for elevated aPL titers and outcomes.
- Multiple logistic regression used to assess interactions with SLE.
Main Results:
- Elevated aPL titers were associated with significantly increased odds of preeclampsia/eclampsia (OR=2.93), SLE (OR=61.24), placental insufficiency (OR=4.58), and prolonged length of stay (PLOS) (OR=3.93).
- Women with both elevated aPL titers and SLE showed a significantly higher likelihood of preeclampsia, placental insufficiency, and PLOS.
- Women with elevated aPL titers were older, more likely white, and less likely to be on Medicaid.
Conclusions:
- This study demonstrates moderate to strong associations between elevated antiphospholipid antibody titers and adverse pregnancy outcomes.
- The findings highlight the importance of screening for aPL in pregnant women, particularly those with SLE.
- These results have implications for risk assessment and management of obstetric complications.
Background:
The primary objective of this study was to determine if elevated antiphospholipid antibody titers were correlated with the presence of preeclampsia/eclampsia, systemic lupus erythematosus (SLE), placental insufficiency, and a prolonged length of stay (PLOS), in women who delivered throughout Florida, USA.
Methods:
Cross-sectional analyses were conducted using a statewide hospital database. Prevalence odds ratios (OR) were calculated to quantify the association between elevated antiphospholipid antibody titers and four outcomes in 141,286 women who delivered in Florida in 2001. The possibility that the relationship between elevated antiphospholipid antibody titers and the outcomes of preeclampsia/eclampsia, placental insufficiency, and PLOS, may have been modified by the presence of SLE was evaluated in a multiple logistic regression model by creating a composite interaction term.
Results:
Women with elevated antiphospholipid antibody titers (n = 88) were older, more likely to be of white race and not on Medicaid than women who did not have elevated antiphospholipid antibody titers. Women who had elevated antiphospholipid antibody titers had an increased adjusted odds ratio for preeclampsia and eclampsia, (OR = 2.93 p = 0.0015), SLE (OR = 61.24 p < 0.0001), placental insufficiency (OR = 4.58 p = 0.0003), and PLOS (OR = 3.93 p < 0.0001). Patients who had both an elevated antiphospholipid antibody titer and SLE were significantly more likely than the comparison group (women without an elevated titer who did not have SLE) to have the outcomes of preeclampsia, placental insufficiency and PLOS.
Conclusion:
This exploratory epidemiologic investigation found moderate to very strong associations between elevated antiphospholipid antibody titers and four important outcomes in a large sample of women.