Maternal cardiolipin, beta(2)-glycoprotein-I and prothrombin antibody expression in high-risk pregnancies with bilateral abnormal uterine artery Doppler waveforms

Objective To compare the frequency of maternal serum antiphospholipid antib odies (to cardiolipin, beta(2)-glycoprotein I and prothrombin) in pregnanci es presenting with bilateral abnormal uterine artery Doppler waveforms. Design Retrospective analysis of stored serum. Subjects Cases comprised 47 singleton pregnancies with bilateral abnormal u terine artery Doppler waveforms at 24 weeks of gestation, followed from 20 weeks, and controls were 100 healthy pregnancies with normal uterine artery Doppler waveforms. Methods Ultrasound examination utilized a 5-MHz curvi-linear transabdominal transducer with pulsed and color Doppler facilities. Antiphospholipid anti bodies were analyzed by ELISA methodology, and reference ranges were establ ished using the geometric mean +/-2 SD of healthy non-pregnant adults. Huma n chorionic gonadotropin (hCG) levels were obtained from patient notes. Results Anticardiolipin antibodies were detected in 11 (23%) of the cases ( IgG, n = 7; IgM, n = 6) compared with ten (10%) of the controls (p < 0.05). Low titer anticardiolipin IgG (range, 5.5-35.3; median, 6.3 GPL units) and anticardiolipin IgM (range, 3.4-14.7; median, 5.3 MPL units) were detected in cases. Amongst the cases, adverse perinatal outcomes were more common i n the presence of raised levels of anticardiolipin antibodies. Anti-beta(2) -glycoprotein I IgG was not detected in any of the cases. Antiprothrombin I gG was not detected, but antiprothrombin IgM occurred in 10.6% of cases com pared with 2% of controls. Conclusions Women with persistent bilateral abnormal uterine artery Doppler waveforms in mid-gestation were more likely to express raised levels of an ticardiolipin antibodies than healthy controls with normal uteroplacental p erfusion. Anticardiolipin antibodies without anti-beta(2)-glycoprotein I bi nding may be involved in the pathogenesis of uteroplacental ischemia in a p roportion of high-risk pregnancies.