Early-onset preeclampsia – the impact of antiphospholipid antibodies on
disease severity: a case-control study
Objective: To evaluate whether early-onset severe preeclampsia prior to
34 weeks’ gestation is clinically different when associated with
antiphospholipid antibodies. Design: A retrospective case-control study.
Setting: Single university-affiliated tertiary referral center
Population: 55 women with singleton pregnancies who delivered prior to
34 weeks’ gestation due to preeclampsia with severe features. Methods:
Out of the 101 women with preeclampsia with severe features, the
antiphospholipid antibodies status of 55 was available for analysis. The
study group comprised 20 women with positive antiphospholipid antibodies
(positive-aPL group), while the control group comprised 35 women without
antiphospholipid antibodies (negative-aPL group). Main outcome measures:
Obstetric and neonatal outcomes, laboratory results and pregnancy
complications. Results: Positive-aPL women were hospitalized earlier
(29, IQR 26.3–32, vs. 32, IQR 28-33 weeks gestation, p=0.05), gave
birth at a significantly earlier gestational age (30, IQR 28.3-32.8 vs.
33, IQR 30-34, p=0.02) with a lower mean birth weight (1266.7±579.6 vs.
1567.3±539.7 grams, p=0.058) compared with negative-aPL women.
Furthermore, platelet nadir was significantly lower for positive-aPL
compared with negative-aPL women (97.2±49.7103/µL vs 141.3±61.13/µL,
p<0.001) and maximal serum creatinine was higher (1.02±0.32
mg/dL vs. 0.92±0.13 mg/dL, p=0.03). Rates of neonatal complications were
low and comparable between groups, although there was a trend for higher
perinatal mortality among study group infants. Conclusions: The presence
of antiphospholipid antibodies in women with early-onset preeclampsia
with severe features is associated with earlier, more severe multi-organ
involvement. Expedited screening for antiphospholipid antibodies in
cases of early-onset severe preeclampsia may be considered.