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Published on: May 21, 2015
Effect of hypocomplementemia on perinatal outcomes of pregnancies with autoimmune disorders
Insights
Preconceptional low complement levels in pregnant women with autoimmune disorders may indicate a history of poor obstetric outcomes. However, standard antenatal care did not show significant differences in perinatal results.
Area of Science:
- Reproductive Immunology
- Maternal-Fetal Medicine
- Autoimmune Disease Research
Background:
- Autoimmune disorders during pregnancy pose risks to both mother and fetus.
- Complement system levels (C3, C4) may serve as biomarkers for pregnancy complications.
- Preconceptional assessment of complement levels in autoimmune pregnancies is not well-established.
Purpose of the Study:
- To investigate the association between preconceptional complement levels and perinatal outcomes in pregnancies affected by autoimmune disorders.
- To evaluate the efficacy of a specific antenatal care protocol in managing these pregnancies.
Main Methods:
- Enrolled pregnant women with autoimmune disorders screened for preconceptional complement levels (C3, C4).
- Administered a treatment regimen including low-dose heparin, aspirin, and corticosteroids.
- Compared obstetric and perinatal outcomes between hypocomplement and normocomplement groups using the Beksac Obstetric Index (BOI).
Main Results:
- No significant differences in obstetric and neonatal outcomes between hypocomplement and normocomplement groups (p>0.05).
- Composite adverse outcome rates were similar in both groups (26.2% vs 27.3%, p>0.05).
- Hypocomplement patients exhibited a significantly lower Beksac Obstetric Index (BOI), indicating a poorer obstetric history (p: 0.002).
Conclusions:
- Low preconceptional complement levels in autoimmune pregnancies may correlate with a history of adverse obstetric events.
- The specific immunomodulatory treatment regimen warrants further investigation for potential benefits in improving outcomes.
Objective:
To demonstrate the effect of preconceptional complement levels on perinatal outcomes of pregnancies with autoimmune disorders.
Methods:
Pregnant women with autoimmune disorders (autoimmune disease and/or autoimmune antibody positivity) who were screened for complement levels (C3 and C4) prior to their pregnancies were enrolled in a special antenatal care program. These patients were administered low-dose low-molecular-weight heparin (enoxaparine, 1 × 2000 Anti-XA IU/0.2 mL/day), low-dose salysilic acid (100 mg/day) and low-dose corticosteroid (methylprednisolone, 1 × 4 mg/day orally) as soon as their pregnancies were confirmed according to the institutional protocol. We have compared hypo- and normocomplement pregnancies with autoimmune disorders in terms of their obstetric and perinatal outcomes. We have also used Beksac Obstetric Index (BOI) which is "[living child + (π/10)]/gravidity" for the comparison of their previous obstetric histories.
Results:
Obstetric and neonatal outcomes showed no significant difference between hypocomplement patients (n= 38) and control group (n= 157) (p> 0.05). "Composite obstetric and perinatal adverse outcome" rates were 26.2% and 27.3% in study and control groups, respectively (p> 0.05). BOI was significantly lower in hypocomplement patients (p: 0.002). Then, we have classified hypocomplement patients into 3 subgroups according to the type of complement (C3, C4 or both). Comparison inbetween these groups revealed no statistical significance in any of the analyzed parameters (p> 0.05).
Conclusion:
Low complement levels in pregnant women with autoimmune disorders may be associated with gestational problems and poor obstetric history. Immunomodulatory treatment modalities such as ours may be beneficial for improving the obstetric and neonatal outcomes.
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