Association between Antiphospholipid Antibodies (APLA) and Preeclampsia (PE) in Females Presenting for Antenatal Check-Up

Introduction: APLA have been associated with a number of obstetric complications however their role in the pathogenesis of preeclampsia has remained an issue of controversy. There is a lack of information on APLA in pre-eclamptic women. Objective: To assess the association between antiphospholipid antibodies (APLA) and preeclampsia (PE) in females presenting for antenatal check-up. Materials and Methods: This Case Control study was conducted in Services Institute of Lahore. After approval from hospital ethical committee, 200 females, fulfilling the inclusion criteria were included in the study from OPD of Department of Obstetrics & Gynecology. Informed consent was obtained. Demographic information was also recorded. The females were divided in two groups on the basis of presence or absence of PE i.e. cases and controls. Results: The mean age of the patients among cases was 27.60±4.96 years the minimum age was 20 years and maximum was 35 years whereas among controls the mean age of the patients was 27.94±4.13 years the minimum age was 20 years and maximum was 35 years .The mean gestational age among cases was 27.46± 4.72 weeks the minimum gestational age was 20 weeks and maximum was 35 weeks on the other side the mean gestational age among controls was 27.25± 4.74 weeks the minimum gestational age was 20 weeks the maximum was 35 weeks. There was significant association between preeclampsia and APLA as the p-value was significant (p-value=0.007). Conclusion: Results of this study showed a significant association and significant risk between APLA and preeclampsia. Therefore a routine assay of APLA in women at risk of preeclampsia should be done. However APLA testing should be considered in women with early onset severe preeclampsia, especially when additional clinical features of APS are present. females for presence of APLA i.e. 10% in preeclampsia group and 0% in control group. 7 Dreyfus reported no association between antiphospholipid antibodies and preeclampsia. The OR for the association was 0.95 (95% CI 0.45, 2.61). APLA were detected 4.4% (8/180) PE women and in 5.3% (19/360) controls. 8 present for development and in and prevent To assess the association between antiphospholipid antibodies (APLA) and preeclampsia (PE) in females presenting for antenatal check-up.


INTRODUCTION
Antiphospholipid antibodies (APLA) are a group of auto-antibodies that have the ability to bind to cardiolipin alone, to cardiolipin complexed to a cofactor or to a cofactor alone. APLA are found in up to 5% of healthy subjects in the general population. The prevalence of APLA in the low risk obstetrical population ranges from 1-9%. 1 APLA promote activation of endothelial cells, monocytes, and platelets; and overproduction of tissue factor and thromboxane A2. Complement activation might have a central pathogenetic role. 2 Antiphospholipid syndrome (APS) is associated with adverse pregnancy outcomes including preeclampsia, recurrent early pregnancy loss, fetal death, and intrauterine growth restriction. Approximately one third of women with APS will develop preeclampsia during pregnancy. 3,4 Antiphospholipid syndrome was first described 27 years ago in patients with systemic lupus erythematosus (SLE) and positive anticardiolipin antibodies, who presented with a clotting syndrome that affected arteries and veins. Female patients had a high risk of recurrent miscarriage and late fetal loss. 5 Current evidence does not justify inclusion of preeclampsia as a major criterion for APS, but preeclampsia could reasonably be included as a secondary or minor criterion in diagnosis when a patient has other clinical features of APS. 3 The presence of antiphospholipid antibodies (APLA) especially anticardiolipin antibodies increased pregnancy risk, as 59.1% IgG or IgM antibodies to one of the six phospholipids (cardiolipin, APS,API,APE, phosphoglycerol and phosphatidicacid) were seen as compared to controls (4.6%). 6  females for presence of APLA i.e. 10% in preeclampsia group and 0% in control group. 7 Dreyfus reported no association between antiphospholipid antibodies and preeclampsia. The OR for the association was 0.95 (95% CI 0.45, 2.61). APLA were detected 4.4% (8/180) PE women and in 5.3% (19/360) controls. 8 Rationale of this study is to determine the association of APLA with PE in females presenting in a tertiary care setting for antenatal check-up. Literature has showed that there is significant association between APLA and PE but there are also contradictions present regarding association of APLA with PE. So we planned this study to find whether there is any impact of APLA for development of PE. Moreover, not much data is available and no local data was found in literature. So we aimed to conduct this study to find local magnitudes and can be able to detect increase in APLA in pregnant females in early gestational age and can prevent PE.

OBJECTIVE
To assess the association between antiphospholipid antibodies (APLA) and preeclampsia (PE) in females presenting for antenatal check-up.

MATERIALS AND METHODS
This Case Control study was conducted in Services Institute of medical sciences, Lahore. The data was collected through Nonprobability consecutive sampling technique.

Data Collection Procedure
After approval from hospital ethical committee, 200 females, fulfilling the inclusion criteria were included in the study from OPD of Department of Obstetrics & Gynecology. Informed consent was obtained. Demographic information (name, age, gestational age, parity and address) was also recorded. The females were divided in two groups on the basis of presence or absence of PE i.e. cases and controls. Blood sample of 12mls were collected from the antecubital vein of each of the study subject and was sent to the laboratory of the hospital to assess APLA (as per operational definition). Reports were assessed to label APLA positive or negative. All this information was recorded on proforma (attached).

Data Analysis
Data was analyzed in SPSS version 20. Mean ± SD was calculated for age and gestational age. Frequency was measured for parity. Odds Ratio was calculated to measure association between APLA and PE. OR>1 was considered statistically significant. Data was stratified for age and parity. Post stratification OR was calculated. OR>1 was considered significant. weeks on the other side the mean gestational age among controls was 27.25± 4.74 weeks the minimum gestational age was 20 weeks the maximum was 35 weeks. Among cases there were 46() women whose parity was 1, 36 women's parity was 2 and 18 women's parity was 3 whereas among controls there were 28 () women's whose parity was 1, 48 women's parity was 2 and 24 women's parity was 2. Among cases there were 17 (17%) women in which Antiphospholipid antibodies were present where as in 83 (83%) APLA was absent, among controls there were 5(5%) women in which Antiphospholipid antibodies were present where as among 95 (95%) APLA was absent. There was significant association between preeclampsia and Antiphospholipid antibodies (APLA) as the p-value was significant (p-value=0.007). The odds ratio is 3.89 which means there are 3.89 time more odds of having preeclampsia if APLA is present in women. (OR=3.89) There was significant association between APLA and preeclampsia in the age group of 20-28 years as the p-value was significant.

Graph-1: Parity Status of Women
(p-value= 0.041) there are 3.34 times more odds of developing preeclampsia in this age group if patient have APLA (OR=3.34) whereas in the age group of 29-36 years there was no significant association between APLA and preeclampsia as the p-value was not significant (p-value=0.066) there are 5.87 times more Odds of developing preeclampsia is the APLA is present in patient. There was no significant association between APLA and preeclampsia among the women whose party was 1 but there were 4.08 times more odds of developing Preeclampsia among those women in which APLA was present where as among women whose parity was 2 there was also no significant association between preeclampsia and APLA and there were 2.09 times more odds of developing preeclampsia if the APLA was present lastly women with parity 3 there was no significant association between Preeclampsia and APLA and there were 4.6 times more odds of developing preeclampsia if APLA was present.