Pathogenetic significance of antiphospholipid antibodies in the development of placenta-associated complications in pregnant women with thrombocytopenia

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Abstract

BACKGROUND: Thrombocytopenia is one of the most common cytopenic syndromes that complicate pregnancy. It is considered a typical hematological criterion and the second most common manifestation of antiphospholipid syndrome. In recent years, the relationship between the development of thrombotic and placenta-associated pregnancy complications and the circulation of antiphospholipid antibodies has been actively studied, which makes it necessary to search for new methods for hemostasis correction and for prevention of the development of obstetric complications.

AIM: The aim of this study was to assess the incidence of antiphospholipid antibodies in pregnant women with thrombocytopenia in order to determine the risk of obstetric complications and adverse pregnancy outcomes depending on the presence of antiphospholipid antibodies in the examined women.

MATERIALS AND METHODS: 299 pregnant women were included in this multicenter prospective study: the main study group (n = 249) consisted of patients with thrombocytopenia, and the control group (n = 50) comprised women with normal platelet counts during a physiological pregnancy. All participants underwent a complete clinical and anamnestic examination and a study of the hemostasis system. To determine antibodies to cardiolipin, beta-2 glycoprotein 1, annexin V, and prothrombin (IgG/IgM/IgA), we performed enzyme-linked immunosorbent assay in 84 pregnant women with thrombocytopenia and in 25 women in the control group. Lupus anticoagulant was determined in 123 pregnant women of the main group and 25 women in the control group using an ACL-200 coagulometer (Instrumentation Laboratory, Spain).

RESULTS: A comparative analysis of antiphospholipid antibodies detection has shown that in pregnant women with thrombocytopenia, lupus anticoagulant was detected in every third case (35.8% of cases, 44/123 women), which is more common than in the control group (8.0% of cases, 2/25 women; p = 0.008). Antibodies to beta-2 glycoprotein 1 were detected in pregnant women with thrombocytopenia in every fourth case (27.4% of cases, 23/84 women), and in the control group only in 4% of cases (1/25 women; p = 0.013). Antibodies to cardiolipin were also more often detected in pregnant women with thrombocytopenia (23.8% of cases, 20/84 women) compared to the control group (4% of cases, 1/25 women; p = 0.040). Based on the data obtained with V Cramer, we established medium-strength direct correlations between criterial antiphospholipid antibodies circulation and the development of placenta-associated complications of pregnancy (p < 0.05; 0.2 < V < 0.4). We also identified statistically significant risks of developing placenta-associated complications in pregnant women with circulating antiphospholipid antibodies (95 % confidence interval excludes 1).

CONCLUSIONS: Thrombocytopenia during pregnancy develops more often in women with antiphospholipid antibodies. Antiphospholipid antibodies circulation elevates coagulation potential and activates intravascular coagulation, resulting in an increased risk of placenta-associated complications of pregnancy, which requires hemostasis correction.

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About the authors

Olga L. Mysik

Prof. V.F. Snegiryov Maternity Hospital No. 6

Email: olga_mysik88@mail.ru
ORCID iD: 0000-0002-8895-6845

MD

Russian Federation, 5 Mayakovskogo St., Saint Petersburg, 192014

Marina S. Zainulina

Prof. V.F. Snegiryov Maternity Hospital No. 6; Academician I.P. Pavlov First St. Petersburg State Medical University

Email: zainulina@yandex.ru
ORCID iD: 0000-0002-2622-5000
Scopus Author ID: 37076359000
ResearcherId: B-5746-2018

MD, Dr. Sci. (Med.), Professor

Russian Federation, 5 Mayakovskogo St., Saint Petersburg, 192014; Saint Petersburg

Kseniya A. Klikunova

Saint Petersburg State Pediatric Medical University

Email: kliksa@gmail.com
ORCID iD: 0000-0002-5978-5557

Cand. Sci. (Phys.-Math.), Assistant Professor

Russian Federation, 5 Mayakovskogo St., Saint Petersburg, 192014

Ekaterina S. Orlova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Author for correspondence.
Email: kate-obstetrician@yandex.ru
ORCID iD: 0000-0002-2203-4987

MD

Russian Federation, 5 Mayakovskogo St., Saint Petersburg, 192014

References

  1. Pestrikova TYu, Yurasova EA, Yurasov IV, et al. Prevention of thromboembolism. Rational approach of maintaining patients in the postoperative period. ConsiliumMedicum. 2018;20(6):53−56. (In Russ.) DOI: 10.26442.2075-1753_2018.6.53-56
  2. Akinshina SV, Bitsadze VO. Pulmonary artery embolism in obstetric practices. Meditsinskiy sovet. 2017;(3):94−105. (In Russ.). doi: 10.21518/2079-701X-2017-13-94-108
  3. Shlyakhtenko TN, Alyab’yeva EA, Arzhanova ON, et al. Antiphospholipid syndrome in miscarriage. Journal of obstetrics and women’s diseases. 2015;64(5):69−76. (In Russ.). doi: 10.17816/JOWD64569-76
  4. Artim-Esen B, Diz-Küçükkaya R, İnanç M. The significance and management of thrombocytopenia in antiphospholipid syndrome. Curr Rheumatol Rep. 2015;17(3):14. doi: 10.1007/s11926-014-0494-8
  5. Vreede AP, Bockenstedt PL, McCune WJ, Knight JS. Cryptic conspirators: a conversation about thrombocytopenia and antiphospholipid syndrome. Curr Opin Rheumatol. 2019;31(3):231−240. doi: 10.1097/BOR.0000000000000595
  6. Trofimov EA, Trofimova AS. The course of antiphospholipid syndrome during pregnancy and its therapy. RMJ. 2016;(15):1032–1036. (In Russ.)
  7. Saccone G, Berghella V, Maruotti GM, et al. Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome: the PREGNANTS study. Am J Obstet Gynecol. 2017;216(5):525.e1−525.e12. doi: 10.1016/j.ajog.2017.01.026
  8. Linnemann B. Antiphospholipid syndrome − an update. Vasa. 2018;47(6):451−464. doi: 10.1024/0301-1526/a000723
  9. Radic M, Pattanaik D. Cellular and molecular mechanisms of anti-phospholipid syndrome. Front Immunol. 2018;9:969. doi: 10.3389/fimmu.2018.00969
  10. Petrishchev NN, Papayan LP, editors. Gemostaz: uchebnoye posobiye. Saint Petersburg: Publishing house of St. Petersburg State Medical University; 1999. (In Russ.)
  11. Satta R, Biondi G. Antiphospholipid syndrome and pregnancy. G Ital Dermatol Venereol. 2019;154(3):277−285. doi: 10.23736/S0392-0488.18.06152-7
  12. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. Obstet Gynecol. 2018;132(1):e1−e17. doi: 10.1097/AOG.0000000000002706
  13. Schatz F, Guzeloglu-Kayisli O, Arlier S, et al. The role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding. Hum Reprod Update. 2016;22(4):497−515. doi: 10.1093/humupd/dmw004
  14. Viall CA, Chamley LW. Histopathology in the placentae of women with antiphospholipid antibodies: A systematic review of the literature. Autoimmun Rev. 2015;14(5):446−471. doi: 10.1016/j.autrev.2015.01.008
  15. Momot AP. Patologiya gemostaza. Printsipy i algoritmy kliniko-laboratornoy diagnostiki. Saint Petersburg: FormaT; 2006. (In Russ.)
  16. Shitikova AS. Trombotsitarnyy gemostaz. Saint Petersburg: Publishing house of St. Petersburg State Medical University; 2000. (In Russ.)
  17. Joseph RE, Radhakrishnan J, Appel GB. Antiphospholipid antibody syndrome and renal disease. Curr Opin Nephrol Hypertens. 2001;10(2):175−181. doi: 10.1097/00041552-200103000-00004
  18. Sammaritano LR. Antiphospholipid syndrome. Best Pract Res Clin Rheumatol. 2020;34(1):101463. doi: 10.1016/j.berh.2019.101463

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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