Antiphospholipid pregnancy outcomes improving

OB/GYN News,  Feb 1, 2003  by Jeff Evans

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NEW ORLEANS -- The live birthrate of neonates born to women with primary antiphospholipid syndrome has risen, and their complications stem mostly from prematurity.

Those findings emerged from two presentations given at the Third International Conference on Sex Hormones, Pregnancy and the Rheumatic Diseases.

Complications from prematurity, rather than maternal disease, accounted for the adverse outcomes of 71 neonates born to women with primary antiphospholipid syndrome (APS), said Dr. Angela Tincani of the University of Milan.

The number of these newborns with intraventricular hemorrhage, periventricular leukomalacia, respiratory distress syndrome, bronchopulmonary dysplasia, retinopathy, and the number admitted to a neonatal intensive care unit did not differ in comparison with 71 control newborns who were matched for gestational age, birth weight, mode of delivery, and obstetric complications.

Overall, 32% of the newborns were premature.

Dr. Tincani said that some case reports have documented thrombosis in infants of APS mothers, but none of the infants in Dr. Tincani's series had a thrombosis. All of the women were treated for primary APS during pregnancy; women in the last 10 years of the study period received heparin and aspirin.

Previous reports did not establish whether maternal antibodies had any effect on the neonate. Some studies, including Dr. Tincani's, suggest that systemic lupus erythematosus--related antibodies, such as anti-Ro and anti-La, but not necessarily antiphospholipid antibodies, may cross the placenta and impair brain development.

Dr. Tincani and her associates prospectively followed 43 patients with primary APS who together had 59 pregnancies from 1984 to 1999. One 8-year-old child had dyslexia, apraxia, and concentration defects; another at 2 months of age was diagnosed with an ischemic brain lesion.

Children born to women with APS secondary to systemic lupus erythematosus also had neuropsychological problems. Among 45 children enrolled after parental interviews, 3 of 8 children aged 4-6 years were unsuccessful in understanding the first or last letter in a simple word. Two of the three children were from anti-Ro--positive mothers, and one was from an antiphospholipid-positive mother. Three of the five children who performed successfully, however, also had mothers who were anti-Ro positive.

Another subset of the 45 children involved 14 children aged 7-16 years. Three of these children were males with learning problems who had a mother positive for antiphospholipids or anti-La. Learning disabilities have been shown previously in sons of patients with APS, Dr. Tincani said at the conference, sponsored by the University of Connecticut and the University of Utah.

A separate poster presentation also demonstrated that neonatal outcomes are improving in women with primary APS. In 35 such women with singleton pregnancies, 91% of infants were born live, said Dr. Munther Khamashta of St. Thomas's Hospital, London.

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