Related Experiment Video
Updated: Mar 28, 2026
Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
Lupus anticoagulant, disease activity and low complement in the first trimester are predictive of pregnancy loss
Anil Mankee1, Michelle Petri2, Laurence S Magder3
1Division of Rheumatology , Icahn School of Medicine at Mount Sinai , New York, New York , USA.
Insights
Lupus anticoagulant in the first trimester strongly predicts pregnancy loss in systemic lupus erythematosus (SLE). Early detection and potential treatment of lupus anticoagulant may improve pregnancy outcomes for women with SLE.
Area of Science:
- Obstetrics and Gynecology
- Rheumatology
- Hematology
Background:
- Systemic lupus erythematosus (SLE) poses significant risks for pregnancy loss due to various factors like proteinuria and antiphospholipid syndrome.
- Previous studies, including the PROMISSE trial, identified a panel of lupus anticoagulant tests as predictive of adverse pregnancy outcomes in SLE.
- This study focuses on the predictive value of a specific lupus anticoagulant test, dilute Russell viper venom time, for pregnancy loss in SLE patients.
Purpose of the Study:
- To evaluate the predictive capability of a baseline lupus anticoagulant test (dilute Russell viper venom time) for pregnancy loss in women with SLE.
- To identify key predictors of pregnancy loss in the first trimester among women diagnosed with SLE.
- To inform potential therapeutic strategies targeting lupus anticoagulant to improve pregnancy outcomes in SLE.
Main Methods:
- Analysis of 202 pregnancies from 175 women in the Hopkins Lupus Cohort, excluding twin pregnancies and those lacking first-trimester lupus anticoagulant assessment.
- Determination of lupus anticoagulant status using dilute Russell viper venom time with appropriate mixing and confirmatory testing.
- Application of generalized estimating equations to account for repeated pregnancies within the same woman and calculate p-values.
Main Results:
- Women with a positive lupus anticoagulant test in the first trimester had a significantly higher rate of pregnancy loss (38%) compared to those without (9%; p=0.003).
- Elevated disease activity and low complement levels in the first trimester were also associated with increased pregnancy loss (p=0.049 and p=0.005, respectively).
- No significant association was found between elevated anticardiolipin levels in the first trimester and pregnancy loss.
Conclusions:
- Lupus anticoagulant detected in the first trimester is the most potent predictor of pregnancy loss in women with SLE.
- Moderate disease activity and low complement levels during early pregnancy also indicate a higher risk of pregnancy loss.
- These findings support considering treatment for lupus anticoagulant, even in the absence of a prior history of pregnancy loss, to potentially mitigate risks.
Introduction:
Multiple factors, including proteinuria, antiphospholipid syndrome, thrombocytopenia and hypertension, are predictive of pregnancy loss in systemic lupus erythematosus (SLE). In the PROMISSE study of predictors of pregnancy loss, only a battery of lupus anticoagulant tests was predictive of a composite of adverse pregnancy outcomes. We examined the predictive value of one baseline lupus anticoagulant test (dilute Russell viper venom time) with pregnancy loss in women with SLE.
Methods:
From the Hopkins Lupus Cohort, there were 202 pregnancies from 175 different women after excluding twin pregnancies and pregnancies for which we did not have a first trimester assessment of lupus anticoagulant. We determined the percentage of women who had a pregnancy loss in groups defined by potential risk factors. The lupus anticoagulant was determined by dilute Russell viper venom time with appropriate mixing and confirmatory testing. Generalised estimating equations were used to calculate p values, accounting for repeated pregnancies in the same woman.
Results:
The age at pregnancy was <20 years (2%), 20-29 (53%), 30-39 (41%) and >40 (3%). 55% were Caucasian and 34% African-American. Among those with lupus anticoagulant during the first trimester, 6/16 (38%) experienced a pregnancy loss compared with only 16/186 (9%) of other pregnancies (p=0.003). In addition, those with low complement or higher disease activity had a higher rate of pregnancy loss than those without (p=0.049 and 0.005, respectively). In contrast, there was no association between elevated anticardiolipin in the first trimester and pregnancy loss.
Conclusions:
The strongest predictor of pregnancy loss in SLE in the first trimester is the lupus anticoagulant. In addition, moderate disease activity by the physician global assessment and low complement measured in the first trimester were predictive of pregnancy loss. These data suggest that treatment of the lupus anticoagulant could be considered, even in the absence of history of pregnancy loss.
Related Concept Videos
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...