Anticardiolipin β2-Glycoprotein I Antibody: Is a High Titer Related to Unfavorable Pregnancy Outcome?

ABSTRACT

We present the clinical characteristics of pregnancy histories and subsequent pregnancy outcomes of 13 women who tested positive for anticardiolipin β2-glycoprotein I antibody (aCLβ2GPI). Six of the 13 women had a history of recurrent spontaneous abortion (RSA). The prevalence of aCLβ2GPI syndrome among women with RSA was very low (2.1%). Other women with aCLβ2GPI were identified by the presence of a biological false-positive serological test for syphilis, intrauterine growth restriction (IUGR), and a history of thrombosis. However, serum aCLβ2GPI titers in the 13 women varied, with a wide range from 3.6 to 1468 U/mL. Their pregnancy histories, subsequent pregnancy outcomes, and complications were compared according to the classification of serum aCLβ2GPI titers as low, moderate, or high. The history of second trimester fetal death was found only in women with high serum aCLβ2GPI titers. All women with high serum aCLβ2GPI titers experienced severe maternal-fetal complications such as IUGR, fetal distress, systemic thromboembolism, and neonatal sequelae in subsequent pregnancies.

KEYWORDS

Anticardiolipin β2-glycoprotein I antibody - antiphospholipid antibody syndrome - intrauterine fetal death - recurrent spontaneous abortion

REFERENCES

• 1 Matsuura E, Igarashi Y, Fujimoto M, Ichikawa K, Koike T. Anticardiolipin cofactor(s) and differential diagnosis of autoimmune disease.  Lancet . 1990;  336 177-178
• 2 McNeil H P, Simpson R J, Chesterman C N, Krilis S A. Antiphospholipid antibodies are directed against a complex antigen that includes a lipid-binding inhibitor of coagulation: β2-glycoprotein I (apolipoprotein H).  Proc Natl Acad Sci U S A . 1990;  87 4120-4124
• 3 Galli M, Comfurius P, Maassen C. et al . Anticardiolipin antibodies (ACA) directed not to cardiolipin but to a plasma cofactor.  Lancet . 1990;  335 1544-1547
• 4 Koike T, Matsuura E. What is the “true” antigen for anticardiolipin antibodies?.  Lancet . 1991;  337 671-672
• 5 Matsuura E, Igarashi Y, Fujimoto M. et al . Heterogeneity of anticardiolipin antibodies defined by the anticardiolipin cofactor.  J Immunol . 1992;  148 3885-3891
• 6 Ozawa N, Makino T, Matsubayashi H. et al . β2-GPI-dependent and independent binding of anticardiolipin antibodies in patients with recurrent spontaneous abortions.  J Clin Lab Anal . 1994;  8 255-259
• 7 Aoki K, Dudkiewicz A B, Matsuura E, Novotny M, Kaberlein G, Gleicher N. Clinical significance of β2-glycoprotein I-dependent anticardiolipin antibodies in the reproductive autoimmune failure syndrome: correlation with conventional antiphospholipid antibody detection systems.  Am J Obstet Gynecol . 1995;  172 926-931
• 8 Katano K, Aoki A, Sasa H, Ogasawara M, Matsuura E, Yagami Y. Beta 2-Glycoprotein I-dependent anticardiolipin antibodies as a predictor of adverse pregnancy outcomes in healthy pregnant women.  Hum Reprod . 1996;  11 509-512
• 9 Gleicher N, el-Roeiy A, Confino E, Friberg J. Is endometriosis an autoimmune disease?.  Obstet Gynecol . 1987;  70 115-122
• 10 Higashino M, Takakuwa K, Arakawa M, Tamura M, Yasuda M, Tanaka K. Anti-cardiolipin antibody and anti-cardiolipin beta-2-glycoprotein I antibody in patients with recurrent fetal miscarriage.  J Perinat Med . 1998;  26 384-389
• 11 Ogasawara M, Aoki K, Katano K, Aoyama T, Kajiura S, Suzumori K. Prevalence of autoantibodies in patients with recurrent miscarriages.  Am J Reprod Immunol . 1999;  41 86-90
• 12 Silveira L H, Hubble C L, Jara L J. et al . Prevention of anticardiolipin antibody-related pregnancy losses with prednisone and aspirin.  Am J Med . 1992;  93 403-411
• 13 Silver R K, MacGregor S N, Sholl J S, Hobart J M, Neerhof M G, Ragin A. Comparative trial of prednisone plus aspirin versus aspirin alone in the treatment of anticardiolipin antibody-positive obstetric patients.  Am J Obstet Gynecol . 1993;  169 1411-1417
• 14 Laskin C A, Bombardier C, Hannah M E. et al . Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal loss.  N Engl J Med . 1997;  337 148-153
• 15 Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies).  BMJ . 1997;  314 253-257
• 16 Kutteh W H. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone.  Am J Obstet Gynecol . 1996;  174 1584-1589
• 17 Wilson W A, Gharavi A E, Koike T. et al . International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop.  Arthritis Rheum . 1999;  42 1309-1311