Placenta · 2026
Histopathological placental findings in antiphospholipid antibody carriers with a fetal loss beyond 12 weeks of pregnancy.
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Beça Sara, Borrell Maria, Santana-Domínguez Marta, Cervera Ricard, Figueras Francesc, Peguero Anna, Nadal Alfons, Espinosa Gerard, Baños Núria
Аннотация
OBJECTIVE: To evaluate the placental histopathological pattern in pregnant women who experienced a fetal loss >12 weeks and were carriers of antiphospholipid antibodies (aPL).
METHODS: Single-center, retrospective cohort study that included consecutive patients who experienced a fetal loss >12 weeks of placental or unknown cause, between January 2019-October 2024. Medical records were reviewed in order to identify carriers of aPL (Lupus anticoagulant [LA], anti-cardiolipin [aCL] IgG/IgM, anti-β2glycoprotein I [aβ2GPI] IgG/IgM and anti-phosphatidylserine/prothrombin [aPS/PT] IgG/IgM antibodies). Histopathological placental findings were recorded according to the standards set by the 2016 Amsterdam Placental Workshop Group, and compared between aPL-positive and aPL-negative women.
RESULTS: A total of 115 women were identified. Testing for aPL was performed in 95.6%. Positivity was recorded in 40. Among the aPL carriers, the mean (standard deviation [SD]) gestational age at fetal death was 26.0 (7.6) weeks. The most frequently detected aPL was aPS/PT IgM, in 72.5%. At least one histopathological lesional pattern was observed in 82.5% of placentas, the most frequent was maternal vascular malperfusion (MVM), in 47.5%. aβ2GPI was significantly associated with MVM. No other associations between the placental pathology patterns and the subtypes or number of positive aPL were observed. Compared to the negative aPL group (n = 66), MVM was more frequent, but the risk of MVM was not significantly increased when adjustment was performed for maternal age, hypertensive disease, smoking and treatment (OR = 1.8, 95% CI 0.64-5.06, p = 0.261).
CONCLUSION: MVM was the most common histopathological lesional pattern in fetal deaths of aPL carriers, although it was present in less than half of patients.
METHODS: Single-center, retrospective cohort study that included consecutive patients who experienced a fetal loss >12 weeks of placental or unknown cause, between January 2019-October 2024. Medical records were reviewed in order to identify carriers of aPL (Lupus anticoagulant [LA], anti-cardiolipin [aCL] IgG/IgM, anti-β2glycoprotein I [aβ2GPI] IgG/IgM and anti-phosphatidylserine/prothrombin [aPS/PT] IgG/IgM antibodies). Histopathological placental findings were recorded according to the standards set by the 2016 Amsterdam Placental Workshop Group, and compared between aPL-positive and aPL-negative women.
RESULTS: A total of 115 women were identified. Testing for aPL was performed in 95.6%. Positivity was recorded in 40. Among the aPL carriers, the mean (standard deviation [SD]) gestational age at fetal death was 26.0 (7.6) weeks. The most frequently detected aPL was aPS/PT IgM, in 72.5%. At least one histopathological lesional pattern was observed in 82.5% of placentas, the most frequent was maternal vascular malperfusion (MVM), in 47.5%. aβ2GPI was significantly associated with MVM. No other associations between the placental pathology patterns and the subtypes or number of positive aPL were observed. Compared to the negative aPL group (n = 66), MVM was more frequent, but the risk of MVM was not significantly increased when adjustment was performed for maternal age, hypertensive disease, smoking and treatment (OR = 1.8, 95% CI 0.64-5.06, p = 0.261).
CONCLUSION: MVM was the most common histopathological lesional pattern in fetal deaths of aPL carriers, although it was present in less than half of patients.