Analysis Of Clinical Characteristics And Pregnancy Outcomes In Patients With Non-criteria Obstetric Antiphospholipid Syndrome

Objective:To analyze the clinical characteristics and pregnancy outcomes of patients with non-criteria obstetric antiphospholipid syndrome（NOAPS）that is beneficial to understand NOAPS patients better and provide a reference for clinical practice,which will contribute to improving the pregnancy outcome.Methods:The clinical data of 198 patients with antiphospholipid syndrome who were delivered in the obstetrics department of The First Affiliated Hospital of Dalian Medical University from January 2018 to May 2022 were collected.Among them 105 cases met the 2006 revised Sydney diagnostic criteria for obstetric antiphospholipid syndrome（OAPS）,while 93 cases met the definition of NOAPS in the"Expert Consensus on Diagnosis and Management of Obstetric Antiphospholipid Syndrome"and were included in the NOAPS group.OAPS patients have been divided into two groups,81cases received low-dose aspirin and low-molecular-weight heparin,while 24 cases did not receive treatment.In the same way,NOAPS patients have been divided into two groups,64 cases received low-dose aspirin and low-molecular-weight heparin,while 29cases did not receive treatment.The clinical manifestations,laboratory investigation results,live birth rate,and pregnancy outcome of patients in each group were compared and analyzed.Results:（1）Statistical analysis of previous pregnancies was shown that the number of pregnancy in the OAPS group was 3.03±1.29,the number of pregnancy in the NOAPS group was2.01±0.99,and there was a significant statistical difference between the two groups（P<0.01）.The incidence of BMI≥28,premature birth,≥3 miscarriages,and incidence of early onset preeclampsia in the OAPS group were higher than in the NOAPS group（P<0.05）.（2）The a PL analysis exposed that LA positive proportion was high in both NOAPS and OAPS groups,that was significantly higher 80%（84/105）in the OAPS group than67.7%（63/93）in the NOAPS group（P<0.05）.Furthermore,LA aCL and aCL anti-β₂GPI double positive rate in the OAPS group was significantly higher（P<0.05）in comparison with the NOAPS group.Besides,there was no significant difference in other a PL types between OAPS and NOAPS groups（P<0.05）.（3）The investigation of the pregnancy outcome demonstrated a strongly significant difference（P<0.01）in the term live birth rate between the treated NOAPS group 85.9%（55/64）and the untreated NOAPS group 17.2%（5/29）.Moreover,the incidences of premature birth,stillbirth,early-onset preeclampsia,FGR,HELLP,and neonatal5-minute APGAR score<7 were significantly different（P<0.05）in the untreated NOAPS group compared to the treated group.Besides,there was a significant difference（P<0.01）in gestational age and birth weight of the newborns in the treated NOAPS group compared to the untreated NOAPS group.There was no statistical difference in the observed pregnancy outcome indicators between the treated NOAPS group and the treated OAPS group（P>0.05）.（4）The Multivariate Logistic regression analysis was shown that not receiving antithrombotic therapy was an independent risk factor for adverse pregnancy outcomes in NOAPS patients（OR=23.171,95%CI 5.176-103.725,P<0.01）.Conclusion:（1）Our study findings evidenced that NOAPS patients are prone to adverse obstetrical events such as premature delivery,miscarriage,stillbirth,preeclampsia,FGR,and HELLP.The treatment with low-dose aspirin and low-molecular-weight heparin antithrombotic therapy improved the pregnancy outcomes of NOAPS patients significantly.（2）There are some differences in clinical characteristics and laboratory indicators between NOAPS and OAPS groups.Furthermore,the pregnancy outcomes of the two types of APS were similar after using and LDA and LMWH,which contributed to significant incidence reduction of adverse pregnancy outcomes and may prevent the development from NOAPS into OAPS.（3）Without treatment increases the risk of adverse pregnancy outcomes in pregnant women with NOAPS.Given the high positive rate of lupus anticoagulant in this study,that recommended to actively screen a PL,especially LA among high-risk pregnant women,and identify as well as use it in NOAPS patients.Antithrombotic therapy,and individualized management,can improve maternal and fetal outcomes of NOAPS.