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Thromb Haemost 2000; 84(02): 228-236
DOI: 10.1055/s-0037-1614001
Review Article
Schattauer GmbH

Antiphospholipid and Antiprotein Syndromes in Non-thrombotic, Non-autoimmune Women with Unexplained Recurrent Primary Early Foetal Loss

The Nîmes Obstetricians and Haematologists Study4 - NOHA4
Jean-Christophe Gris
1   From Laboratoire d’Hématologie, Faculté de Pharmacie, Montpellier, Nîmes, France
2   Laboratoire d’Hématologie, Centre Hospitalier Universitaire, Nîmes, France
3   E.A. M.E.N.R.T. “Dynamique des incohérences cardio-vasculaires”, Nîmes, France
,
Isabelle Quéré
3   E.A. M.E.N.R.T. “Dynamique des incohérences cardio-vasculaires”, Nîmes, France
4   Service de Médecine Interne B et Maladies Vasculaires, CHU, Montpellier, Nîmes, France
,
Marielle Sanmarco
5   Fédération AutoimmunitéThrombose, Hôpital de la Conception, CHU, Marseille, Nîmes, France
,
Brigitte Boutiere
5   Fédération AutoimmunitéThrombose, Hôpital de la Conception, CHU, Marseille, Nîmes, France
,
Eric Mercier
2   Laboratoire d’Hématologie, Centre Hospitalier Universitaire, Nîmes, France
,
Jean Amiral
6   SERBIO, Gennevilliers, Nîmes, France
,
Anne-Michèle Hubert
5   Fédération AutoimmunitéThrombose, Hôpital de la Conception, CHU, Marseille, Nîmes, France
,
Sylvie Ripart-Neveu
7   Département de Gynécologie et Obstétrique, CHU, Nîmes, France
,
Méderic Hoffet
7   Département de Gynécologie et Obstétrique, CHU, Nîmes, France
,
Marie-Laure Tailland
7   Département de Gynécologie et Obstétrique, CHU, Nîmes, France
,
Olivier Rousseau
7   Département de Gynécologie et Obstétrique, CHU, Nîmes, France
,
Françoise Monpeyroux
8   Département d’Information Médicale, CHU, Nîmes, France
,
Michel Dauzat
3   E.A. M.E.N.R.T. “Dynamique des incohérences cardio-vasculaires”, Nîmes, France
,
José Sampol
5   Fédération AutoimmunitéThrombose, Hôpital de la Conception, CHU, Marseille, Nîmes, France
,
Jean-Pierre Daures
8   Département d’Information Médicale, CHU, Nîmes, France
,
Jacques Berlan
1   From Laboratoire d’Hématologie, Faculté de Pharmacie, Montpellier, Nîmes, France
,
Pierre Marès
7   Département de Gynécologie et Obstétrique, CHU, Nîmes, France
› Author AffiliationsWe thank all the women from the French regions Languedoc-Roussillon and Provence-Alpes-Côte d’Azur who participated in the study. We acknowledge all the physicians who referred their patients to our team, and particularly H Coulondre, R Delpon de Vaux, D Dupaigne, C Ferrer, MP Le Gac, B Galan, F Jamet, P Quirot, E Ranque, J Vedel and S Wright for their contribution to the study. We are indebted to technicians Mr. Christian Sarlat, Mrs. Christine Galtier, Madeleine Gayraud, Françoise Vassas and Marie-Thérèse Dantan for their excellent assistance in laboratory analysis. We thank Margaret Manson for editorial assistance. We thank Marie-Claire Boffa for fruitful discussion and for expert editorial assistance.
Further Information

Publication History

Received 14 December 1999

Accepted after resubmission 13 March 2000

Publication Date:
14 December 2017 (online)

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Summary

Various antiphospholipid and/or antiprotein antibodies have been suspected to be associated with recurrent early foetal loss in absence of any habitual aetiology. We conducted a hospital-based case control study on women with no antecedent of thromboembolic or autoimmune disease. We studied 3 groups of 518 women: patients with unexplained primary recurrent early foetal loss, patients with explained episodes and mothers with no previous obstetrical accident. Matching the 3 groups was carried out on the basis of age, number or pregnancies and time elapsed since the end of the last pregnancy. Significant biological markers were then prospectively tested.

The various antibodies were shown to be dependent on parity and on the presence of previous foetal loss: cut-off values were thus calculated using data obtained from the group of explained accidents, and adjusted for parity. Only anti-phosphatidylethanolamine IgM [odds ratio: 6.0, 95% confidence interval (2.3–15.7), p = 0.0003], anti-β2-glycoprotein I IgG [4.4, (1.6–11.7), p = 0.0035] anti-annexin V IgG antibodies [3.2 (1.2–8.1), p = 0.015] and lupus anticoagulant [3.0, (1.3–6.8), p = 0.009], were found to be independent retrospective risk factors for unexplained early foetal loss. These four markers were subsequently found to be, during the following pregnancy, associated with a significant risk of foetal loss despite a low-dose aspirin treatment.

In non-thrombotic, non-auto-immune women with unexplained primary reccurent early foetal loss, subgroups of patients with positive anti-phosphatidylethanolamine IgM antibodies, or positive anti- β2-glycoprotein-I IgG antibodies, or positive anti-annexin V IgG anti-bodies or lupus anticoagulant must be particularised. This should allow therapeutic trials to be carried in well-defined patients.

Key words

Foetal loss - antiphospholipid antibodies - β2 glycoprotein I - annexin V - phosphatidylethanolamine
 

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