• Immunological causes of fetal development retardation syndrome in pregnant women with antiphospholipid syndrome
en To content

Immunological causes of fetal development retardation syndrome in pregnant women with antiphospholipid syndrome

HEALTH OF WOMAN. 2019.9(145): 50–54; doi 10.15574/HW.2019.145.50
Yu.P. Vdovichenko1, N.A. Firsova2, V.V. Maksimova2
1Shupyk National Medical Academy of Postgraduate Education, Kiev
2Medical Center «Isida-IVF», Kiev

Objective: to conduct a comparative analysis of the level of antibodies to phospholipids, the concentration of the pro-inflammatory cytokine TNF-α, as well as their correlation with the severity of fetal development retardation syndrome (FDS) and the outcome of pregnancy.

Materials and methods. There was conducted a study of 285 pregnant women with FDS for the presence of antibodies to β2GPI as the most specific marker of the autoimmune process of APS in pregnancy 23–36 weeks. Group I included 103 (36.1%) women with a positive test for the presence of antibodies to β2GPI, group II (control) – 27 pregnant women of the same age and gestational age with physiological pregnancy.

To study the immunological status, the titer of antibodies of the IgM and IgG class against cardiolipin was determined using enzyme immunoassay test systems produced by the «Genesis Diagnostics» company (Great Britain), and the titer of antibodies of the IgM class, IgG to β2GPI was tested using the «Biotech Inc» test systems (USA).

Tests for the quantitative study of human TNF-α are based on the method of enzyme-linked immunosorbent assay using specific monoclonal antibodies TNF-α.

Results. A statistically significant increase in all classes of antiphospholipid antibodies and TNF-α was revealed in pregnant women with FDS with an increase in gestational age compared with the control group. A significant increase in the levels of AKLA and antibodies to β2GPI IgG class in the II trimester (p <0.05) is also characteristic of pregnant women with FDS with a tendency to increase indicators in the III trimester. So, the average level of AKLA IgG in the II trimester was increased by 12.1 times; antibodies to β2GPI IgG – 7.4 times. In the III trimester, the average level of IgG AKLA was 11.7 times higher in comparison with the average level of similar indicators of the control group, and the average level of antibodies to β2GPI IgG class was 7.6 times higher than that in pregnant women with physiological pregnancy. A statistically significant direct correlation between the severity of FDS and the level of antibodies to β2GPI IgG (r = 0.61; p <0.01), SZRP and TNF-α (r = 0.41; p <0.01) was also revealed.

Conclusion. The results of the study make it possible to predict the severity of FDS depending on the level of autoantibodies and indicators of the pro-inflammatory cytokine TNF-α, as well as determine the intensity and effectiveness of the treatment and preventive measures.

Key words: pregnancy, antiphospholipid syndrome, fetal development retardation syndrome, tumor necrosis factor.

REFERENCES

1. Alehnovich LI, Stepanova YuI. 2010. Kliniko-laboratornyie aspektyi antifosfolipidnogo sindroma. ARS MEDICA. 4 (24): 23–27.

2. Veropotvelyan PN, Veropotvelyan NP. 2011. Trombofilii i beremennost. Zdorove Ukrainy 9/10 (50): 30–34.

3. Kiryuschenkov PA. 2010. Fiziologiya sistemyi gemostaza i ee osobennosti pri neoslozhnennoy beremennosti. Effektivnaya farmakoterapiya v akusherste i ginekologii 4:16–20.

4. Makatsariya AD, Bitsadze VO. 2010. Antifosfolipidnyiy sindrom. M:32.

5. Bouvier S, Cochery-Nouvellon E, Lavigne-Lissalde G et al. 2014. Comparative incidence of pregnancy outcomes in treated obstetric antiphospholipid syndrome: the NOH-APS observational study. Blood 123: 404–417. https://doi.org/10.1182/blood-2013-08-522623; PMid:24200687

6. De Carolis S, Tabacco S, Rizzo F et al. 2018. Antiphospholipid syndrome: an update on risk factors for pregnancy outcome. Autoimmun Rev 17: 956–1022. https://doi.org/10.1016/j.autrev.2018.03.018; PMid:30118899

7. Giasuddin ASM, Mazhar I, Mulibul Hag AM. 2010. Prevalence of anticardiolipin antibody in Bangladeshi patients with recurrent pregnancy loss. Bangladesh Med. Res. Counc. Bull. 36: 10–13. https://doi.org/10.3329/bmrcb.v36i1.5446; PMid:21280552

8. Howard JA, Carp MB. 2014. Aspirin in recurrent miscarriage: is there an indication? IMAJ. 11:178–182.

9. Latino JO, Udry S, Aranda FM et al. 2017. Pregnancy failure in patients with obstetric antiphospholipid syndrome with conventionaltreatment: the influence of a triple positive antibody profile. Lupus. 26: 983–991. https://doi.org/10.1177/0961203317692432; PMid:28173738

10. Mekinian A, Loire-Berson P, Nicaise-Roland P et al. 2012. Outcomes and treatment of obstetrical antiphospholipid syndrome in women with low antiphospholipid antibody levels. J Reprod Immunol. 94: 222–228. https://doi.org/10.1016/j.jri.2012.02.004; PMid:22386067

11. Rezk M, Dawood R, Badr H. 2016. Maternal and fetal outcome in women with antiphospholipid syndrome: a three-year observational study. J Matern Fetal Neonatal Med. 29: 4015–4024. https://doi.org/10.3109/14767058.2016.1152254; PMid:26856354

12. Saccone G, Berghella V, Maruotti GM et al. 2017. Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome: the PREGNANTS study. Am J Obstet Gynecol. 216: 525–536. https://doi.org/10.1016/j.ajog.2017.01.026; PMid:28153662

13. Satta R, Biondi G. 2019. Antiphospholipid syndrome and pregnancy. G Ital Dermatol Venereol. 154: 277–285. https://doi.org/10.23736/S0392-0488.18.06152-7; PMid:30375212

14. Szecsi PB, Jorgensen M, Klajnbard A et al. 2010, Mar 31. Haemostatic reference intervals in pregnancy. Thrombosis And Haemostasis. 103 (4): 718–727. https://doi.org/10.1160/TH09-10-0704; PMid:20174768