Brief report: changes in antiphospholipid antibody titers during pregnancy: effects on pregnancy outcomes
Open accessAbstract
OBJECTIVE: To measure variance in antiphospholipid antibody (aPL) levels during pregnancy and to determine if variation affects pregnancy outcomes. METHODS: We used data from the PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) study, a multicenter prospective study of pregnant women with aPL and/or systemic lupus erythematosus (SLE). Antiphospholipid antibodies were considered present if any of the following were positive: anticardiolipin (aCL), anti-β2 -glycoprotein I (anti-β2 GPI) titers ≥40 IgG phospholipid (GPL) or IgM phospholipid (MPL) units, and/or lupus anticoagulant (LAC). Antiphospholipid antibodies were measured every trimester and postpartum. Adverse pregnancy outcomes were defined as fetal/neonatal death, preterm delivery (<36 weeks) due to preeclampsia or placental insufficiency, or growth restriction. RESULTS: One hundred fifty-two aPL-positive patients were studied. Fifty-seven percent had clinical antiphospholipid syndrome (APS) and 36% had SLE. IgG aPL levels were significantly lower during the second and third trimesters compared to initial screening, but IgG aCL and anti-β2 GPI remained high-positive through pregnancy in 93% of patients during the second trimester, and in 85% of patients during the third trimester. IgM aPL titers were negative in the majority of patients and decreased modestly during pregnancy among patients who were positive. LAC frequency also decreased, but 75% of patients remained positive through the second trimester. Only 4% of patients with aPL at baseline did not have aPL in either the second or third trimesters. Changes in aPL levels or aPL status were not associated with adverse pregnancy outcomes. LAC was the only aPL associated with adverse pregnancy outcomes. CONCLUSION: The aPL in the cohort decreased marginally during pregnancy, and changes were not associated with pregnancy outcomes. Our results suggest that, among women with aPL and/or SLE, measuring aPL early in pregnancy is sufficient to assess risk. Repeat aPL testing through pregnancy is unnecessary.
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LA positivity can fluctuate over time, with or without systemic lupus erythematosus, and during pregnancy it may decrease or increase.
“LA positivity may fluctuate over time with or without the presence of systemic lupus erythematosus 22,23 and during pregnancy, either decreasing or increasing.22,24,25”
From Guidance from the Scientific and Standardization Committee for lupus anticoagulant/antiphospholipid antibodies of the International Society on Thrombosis and Haemostasis (2020) · cites this paper as [23]
The Results section (page unavailable) reports that LAC positivity declined during pregnancy among women positive at screening, while 18% of those negative at screening became positive by the second trimester. The study included women with and without SLE, but reports these changes for the group overall; it does not establish that LAC positivity fluctuates in each SLE subgroup or outside pregnancy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn one study, LA results returned to baseline by three months after delivery.
“LA results returned to baseline status by 3 months postdelivery in one study.23”
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- Authors
- Yelnik, C. M., Porter, T. F., Branch, D. W., Laskin, C. A., Merrill, J. T., Guerra, M. M., Lockshin, M. D., Buyon, J. P., Petri, M., Sammaritano, L. R., Stephenson, M. D., Kim, M. Y., & Salmon, J. E.
- Affiliations
- University of Lille Lille France
- Intermountain Healthcare (US)
- University of Toronto (CA)
- Oklahoma Medical Research Foundation (US)
- Hospital for Special Surgery (US)
- New York University (US)
- Johns Hopkins University (US)
- University of Illinois Chicago (US)
- Albert Einstein College of Medicine (US)
- Corresponding author
- Salmon, Jane E.
- ORCID
- Venue
- Arthritis & Rheumatology
- Publisher
- Wiley
- Published
- 2016-07-27
- Volume
- 68
- Issue
- 8
- Pages
- 1964-1969
- ISSN
- 2326-5191 (ISSN-L)
- 2326-5205
- PMC
- PMC5380363
- OpenAlex
- W2503936993
- Cited by
- 54
- References
- 17
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 5 · 2023: 7 · 2022: 8 · 2021: 3 · 2020: 6 · 2019: 2 · 2018: 5 · 2017: 4
- FWCI
- 3.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Arthritis & Rheumatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH (AR-49772)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- antiphospholipid antibodies, pregnancy outcomes, antiphospholipid syndrome, systemic lupus erythematosus, anticardiolipin antibodies, anti-beta2-glycoprotein I antibodies, lupus anticoagulant, antibody titers, adverse pregnancy outcomes, preterm birth, fetal death
- MeSH terms
- Adult, Female, Humans, Lupus Erythematosus, Systemic, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prospective Studies, Antiphospholipid Syndrome, Antibodies, Antiphospholipid, Risk Assessment
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