Recurrent miscarriage and low-titer antiphospholipid antibodies

Area of Science:

• Reproductive Medicine
• Immunology
• Obstetrics

Background:

• Recurrent miscarriage (RM) is a complex condition often associated with antiphospholipid antibodies (aPL).
• The impact of low-titer aPL positivity on pregnancy outcomes compared to medium-high titers requires further elucidation.
• Understanding these differences is crucial for optimizing management strategies.

Purpose of the Study:

• To compare clinical features and pregnancy outcomes in patients with recurrent miscarriage and low-titer versus medium-high titer antiphospholipid antibodies.
• To identify specific antibody profiles and inflammatory markers associated with different aPL titer groups.
• To evaluate the effectiveness of treatment strategies in improving pregnancy success in these patient cohorts.

Main Methods:

• Retrospective review of medical records for 118 patients with aPL positivity and recurrent miscarriage (2018-2022).
• Comparison of clinical features, antibody types (IgM, IgG for anti-cardiolipin and anti-β2-glycoprotein 1), erythrocyte sedimentation rate, treatment, and outcomes between low-titer (n=92) and medium-high titer (n=32) aPL groups.
• Statistical analysis to determine significant differences between the groups.

Main Results:

• Distinct antibody profiles were observed: low-titer group showed more anti-cardiolipin IgM, while medium-high titer group had more anti-β2-glycoprotein 1 IgG and IgM.
• The medium-high titer group exhibited a significantly higher erythrocyte sedimentation rate.
• Despite differences in antibody prevalence and inflammation markers, treatment led to comparable live birth rates (67.6% vs. 79.3%) and low rates of repeat abortions (32.4% vs. 20.7%) in both groups, with no significant maternal-fetal complications.

Conclusions:

• Laboratory parameters differ significantly between low-titer and medium-high titer aPL-positive recurrent miscarriage patients.
• Appropriate treatment ensures comparable and favorable maternal-fetal outcomes in both low and medium-high titer aPL groups.
• This study highlights the critical importance of timely clinical intervention for patients with low-titer aPL-positive recurrent miscarriage, challenging the notion that only high titers predict adverse outcomes.