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The association of antiphospholipid antibodies with pregnancies complicated by fetal growth restriction
W J Polzin1, J N Kopelman, R D Robinson
1Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, Washington.
Insights
Maternal anticardiolipin antibodies are significantly associated with fetal growth restriction. This study found a higher prevalence of these antibodies in women with growth-restricted fetuses, suggesting a link.
Area of Science:
- Obstetrics and Gynecology
- Immunology
- Perinatal Medicine
Background:
- The link between antiphospholipid antibodies and fetal growth restriction (FGR) is suggested but lacks robust evidence.
- Previous studies relied on historical data and small patient groups.
Purpose of the Study:
- To prospectively investigate the association between antiphospholipid antibodies and FGR.
- To evaluate the prevalence of lupus anticoagulant and anticardiolipin antibodies in women with suspected FGR.
Main Methods:
- Prospective study of 55 women with fetuses at or below the tenth percentile for gestational age.
- Plasma and serum testing for lupus anticoagulant and anticardiolipin antibodies.
- Intensive fetal monitoring and activity modification.
Main Results:
- 37 newborns (67%) confirmed with FGR.
- 15 of 55 women (27%) tested positive for anticardiolipin antibodies.
- A statistically significant association was found between anticardiolipin antibodies and FGR; lupus anticoagulant was not detected.
Conclusions:
- Circulating maternal anticardiolipin antibodies are significantly associated with fetal growth restriction.
- This finding supports a role for anticardiolipin antibodies in the pathophysiology of FGR.
Abstract:
The association of antiphospholipid antibodies with fetal growth restriction is often cited, but the published evidence for this is based on few patients and comes primarily from patient histories, not study groups. In this prospective study, we evaluated a subgroup of our population with fetuses whose estimated weights at ultrasound were at or below the tenth percentile for gestational age. Plasma and serum testing was performed to determine the presence of antiphospholipid antibodies, specifically lupus anticoagulant and anticardiolipin antibodies, respectively. From March 1990 through March 1991, 55 women were followed for suspected fetal growth restriction. Intensive monitoring of the fetal condition and modification of the mother's activity were recommended, resulting in 100% compliance. Despite this, 37 newborns were confirmed by birth weight to be at or below the tenth percentile, and all were below the 45th percentile. Fifteen of 55 women (27%) were positive for anticardiolipin antibodies, as were nine of 37 (24%) with correctly diagnosed fetal growth restriction. Five of 15 women whose newborns had ponderal indexes below the tenth percentile tested positive for anticardiolipin antibodies. None of the women had a positive lupus anticoagulant test. The prevalence of anticardiolipin antibodies in this study group was significantly higher than in our general population. We conclude that there is a statistically significant association between the presence of circulating maternal anticardiolipin antibodies and fetal growth restriction.