Risk factors associated with fetal losses in treated antiphospholipid syndrome pregnancies: A multivariate analysis

PROBLEM: Pregnancies in women with antiphospholipid syndrome (APS) are asso ciated with obstetric complications despite treatment. The present study an alyzes risk factors and evaluates fetal outcome in a large sample of treate d APS pregnancies. METHOD OF STUDY: Seventy-seven pregnancies in 56 women were included. Twelv e selected variables potentially related to the outcome of treated pregnanc ies were analyzed in a multivariate logistic regression model. RESULTS: Treated women delivered 65 live infants at 24-41 weeks gestation ( mean 36.7 +/- 0.5) but two neonatal deaths occurred. There were seven first -trimester miscarriages (9%) and five intrauterine fetal demises (6.5%). Th us, the probability of having a live baby under treatment was 82% (95% CI 7 1.3-89.6%), a figure significantly greater (P<0.001) than that observed bef ore therapy (25.7%; 95% CI 18.7-33.7%). Variables related with fetal outcom e in the multivariate model were: preconceptional use of aspirin and abnorm al umbilical artery Doppler velocimetry at 23-26 weeks gestation. CONCLUSIONS: The present report shows that in treated APS pregnancies: i) a spirin treatment started preconceptionally is an independent and significan t prognostic factor associated with favorable fetal outcome; and ii) abnorm al velocity waveforms in the umbilical artery predict adverse outcome of pr egnancy.