Introduction
Hypertensive disorders of pregnancy remain one of the leading causes of
maternal and perinatal morbidity and mortality. It is estimated that
preeclampsia complicates 2-8% of pregnancies,1-4 and
is classically characterized by new onset of hypertension and
proteinuria1-3,5 although clinical presentations may
vary.6 Preeclampsia can be defined as either
non-severe or severe, depending on the severity of hypertension or the
presence of specific clinical or laboratory criteria (i.e. HELLP
syndrome, eclampsia, etc).7-10 Preeclampsia with
severe features may lead to end organ damage, including the central
nervous system, cardiovascular system, coagulation, liver and
kidney.11 Early-onset preeclampsia before 34 weeks’
gestation is generally associated with a more severe clinical course for
the mother, as well as neonatal complications related to
prematurity.12-13 Although the exact pathogenesis of
preeclampsia in not fully appreciated, several clinical risk factors
have been identified, such as nulliparity, previous history of
preeclampsia, multifetal gestation, pregestational diabetes, chronic
hypertension, renal disease, obesity, thrombophilia, systemic lupus
erythematosus as well as antiphospholipid antibody
syndrome.14-16
Antiphospholipid syndrome (APS) is an autoimmune, hypercoagulable state
caused by the presence of antiphospholipid antibodies (aPL antibodies).
aPL antibodies have been associated with a variety of obstetric
complications, including recurrent pregnancy loss, and placental
mediated complications, such as early-onset preeclampsia, intrauterine
growth restriction, placental insufficiency, placental abruption,
preterm delivery and late fetal loss.17-23
Despite the amassed body of evidence describing the association between
aPL antibodies and preeclampsia, the significance of the presence of aPL
antibodies in preeclamptic women with severe features has not been
thoroughly elucidated. Specifically, it is unclear whether early-onset
severe preeclampsia before 34 weeks gestation presents with different
clinical features when associated with antiphospholipid antibodies.
Therefore, the aim of our study was to determine if the presence of aPL
antibodies is associated with different maternal or neonatal clinical
characteristics in those with early-onset preeclampsia who delivered
prior to 34 weeks.