Reassessing the role of antiphospholipid antibodies in placental-mediated adverse pregnancy outcomes in systemic lupus erythematosus: A retrospective cohort study.

OBJECTIVE

To examine how different antiphospholipid antibody (aPL) profiles influence placental-mediated adverse pregnancy outcomes (APOs) in women with systemic lupus erythematosus (SLE).

METHODS

This retrospective cohort study included 245 pregnant women with SLE and 490 controls from a single center. Clinical features, immunologic markers and aPL profiles were analyzed. Logistic regression models were used to explore associations between antiphospholipid syndrome (APS), individual aPL subtypes, antibody burden and placental-mediated APOs.

RESULTS

Placental-mediated APOs occurred more often in SLE pregnancies than in controls (27.8% vs. 9.8%). After adjustment, APS was not independently associated with APOs. Renal involvement, chronic hypertension and hypocomplementemia remained significant predictors (P < 0.05). Among antibody types, lupus anticoagulant (LAC) showed the strongest association in univariate analysis, but the effect weakened in multivariable analysis. Women with multiple aPL positivity had a higher risk of placental complications, whereas single positivity showed little independent effect.

CONCLUSION

In SLE pregnancies, obstetric risk is not explained by APS alone. Antibody burden, especially multiple aPL positivity, together with renal disease, hypertension and complement levels appears more informative for assessing placental-related risk.