Antiphospholipid antibodies in women at risk for preeclampsia

OBJECTIVE: The aim of this study was to determine whether positive results of tests for any of 5 antiphospholipid antibodies are associated with recur rent preeclampsia among women with a history of preeclampsia in a previous pregnancy. STUDY DESIGN: Second-trimester serum samples were obtained from 317 women w ith preeclampsia in a previous pregnancy who were being followed up in a pr ospective treatment trial. The serum samples were measured by enzyme-linked immunoassay for immunoglobulin G and immunoglobulin M antibodies against 5 phospholipids. Positive results were analyzed with regard to preeclampsia, severe preeclampsia, intrauterine growth restriction, and preterm delivery . RESULTS: Sixty-two of the 317 women (20%) had recurrent preeclampsia develo p, 19 (6%) had severe preeclampsia, and 18 (5.8%) were delivered of infants with growth restriction. Positive results of tests for immunoglobulin G or immunoglobulin M antiphospholipid antibodies were not associated with recu rrent preeclampsia. Positive results for immunoglobulin G or immunoglobulin M antibodies at the 99th percentile were also not associated with preterm delivery. Positive results at the 99th percentile for immunoglobulin G anti phosphatidylserine antibody were associated with severe preeclampsia, and p ositive results at the 99th percentile for immunoglobulin G anticardiolipin , antiphosphatidylinositol, and antiphosphatidylglycerol antibodies were as sociated with intrauterine growth restriction. The positive predictive valu es for these outcomes all were approximately 30%. CONCLUSION: Positive results of testing for antiphospholipid antibodies in the second trimester were not associated with recurrent preeclampsia among women at risk because of a history of preeclampsia. Positive results for im munoglobulin G antiphosphatidylserine antibody were associated with severe preeclampsia, and positive results for immunoglobulin G anticardiolipin, an tiphosphatidylinositol, and antiphosphatidylglycerol antibodies were associ ated with intrauterine growth restriction. However, the positive predictive values for all these associations were modest. Testing for antiphospholipi d antibodies during pregnancy is of little prognostic value in the assessme nt of the risk for recurrent preeclampsia among women with a history of pre eclampsia.