Antiphospholipid and antiprotein syndromes in non-thrombotic, non-autoimmune women with unexplained recurrent primary early foetal loss - The Nimes Obstetricians and Haematologists Study(4) NOHA(4)

Various antiphospholipid and/or antiprotein antibodies have been suspected to be associated with recurrent early foetal loss in absence of any habitua l aetiology. We conducted a hospital-based case control study on women with no antecedent of thromboembolic or autoimmune disease. We studied 3 groups of 518 women: patients with unexplained primary recurrent early foetal los s, patients with explained episodes and mothers with no previous obstetrica l accident. Matching the 3 groups was carried out on the basis of age, numb er or pregnancies and time elapsed since the end of the last pregnancy. Sig nificant biological markers were then prospectively tested. The various antibodies were shown to be dependent on parity and on the pres ence of previous foetal loss: cut-off values were thus calculated using dat a obtained from the group of explained accidents, and adjusted for parity. Only anti-phosphatidylethanolamine IgM [odds ratio: 6.0, 95% confidence int erval(2.3-15.7), p = 0.0003], anti-beta 2-glycoprotein I IgG [4.4, (1.6-11. 7), p = 0.0035] anti-annexin V IgG antibodies [3.2 (1.2-8.1), p = 0.015] an d lupus anticoagulant [3.0, (1.3-6.8), p = 0.009], were found to be indepen dent retrospective risk factors for unexplained early foetal loss. These fo ur markers were subsequently found to be, during the following pregnancy, a ssociated with a significant risk of foetal loss despite a low-dose aspirin treatment. In non-thrombotic, non-auto-immune women with unexplained primary reccurent early foetal loss, subgroups of patients with positive anti-phosphatidylet hanolamine IgM antibodies, or positive anti-beta 2-glycoprotein-I Ige antib odies, or positive anti-annexin V IgG antibodies or lupus anticoagulant mus t be particularised. This should allow therapeutic trials to be carried in well-defined patients.