Presenter of 2 Presentations
O123 - ASSOCIATION BETWEEN PRECONCEPTION COMPLEMENT LEVELS AND USE OF HYDROXYCHLOROQUINE WITH PREGNANCY OUTCOME IN PATIENTS WITH ANTIPHOSPHOLIPID SYNDROME AND CARRIERS OF ANTIPHOSPHOLIPID ANTIBODIES:AN INTERNATIONAL MULTICENTER STUDY (ID 120)
Abstract
Background and Aims
Complement was demonstrated to be involved in antiphospholipid antibodies (aPL)-related pregnancy loss in animal models and human disease. Hydroxychloroquine (HCQ) can control the activation of the complement system, could improve pregnancy outcome and to reduce aPL title. This study was conducted to verify the effect of HCQ in a multicenter cohort of primary antiphospholipid syndrome (PAPS) and aPL carriers pregnant women and possible correlation with preconception serum C3/C4 levels.
Methods
We retrospectively evaluated 164 pregnancies (22 aPL carriers-13%) in 128 patients with confirmed positivity for aPL attending 12 referral centers from January 2010 to December 2020. All the patients were treated with combination therapy (low dose aspirin, LDA + low molecular weight heparin, LMWH), in 30 HCQ was added. 58 pregnancies (43%)had low levels of preconception C3/C4. Triple aPL positivity was observed in 54 pregnancies(40%).
Results
In the whole cohort and in the group of patients with preconception low C3/C4, the addition of HCQ on the top of combination therapy did not significantly improved the gestational outcome(see table). In the 40 pregnancies characterized by a high-risk profile(triple aPL positivity and complement consumption) HCQ significantly improved gestational outcome.
Conclusions
The study shows that administering HCQ in addition to combination therapy can improve gestational outcome in aPL/APS high-risk patients. This observation confirms that HCQ exerts a beneficial effect on aPL pregnancies by complement inhibition as it was shown in animal models. In addition, our results provide the clinicians a useful tool to implement conventional treatment in patients at high risk of pregnancy complication or loss.
O137 - THE INTERPLAY BETWEEN THE THYROID AND ANTIPHOSPHOLIPID ANTIBODIES: CAN ANTI-THYROPEROXIDASE ANTIBODIES CONTRIBUTE TO THE RISK OF ADVERSE PREGNANCY OUTCOMES? (ID 420)
Abstract
Background and Aims
Anti-thyroperoxidase antibodies(aTPO) are the hallmark of Hashimoto’s Thyroiditis, but can be also found in euthyroid individuals(detected in up to 11.3% of the population). There are hints at aTPO being a risk factor for adverse pregnancy outcomes(APO). Antiphospholipid antibodies(aPL) are well-recognized pathogenic autoantibodies that can cause APO. The aim of our study was to retrospectively review our cohort of aPL positive pregnant patients with known results for aTPO in order to assess their contribution to APO.
Methods
We reviewed clinical charts of pregnant women followed-up at our Pregnancy Clinic from 2018 to 2021 and retrieved 53 patients with preconception confirmed positivity for aPL and known results for aTPO. APO(fetal death, IUGR, preterm birth, PROM, SGA) and thyroid function exams were collected.
Results
All 53 women were in spontaneous euthyroidsm. aTPO were positive in 17/53 patients(32%). aPL profile for aTPO positive patients was 8 single positivity, 7 double and 2 triple, while for aTPO negative patients there was 8 single positivity, 7 double and 2 triple. The table shows the frequency of APO upon aTPO positivity and thyroid function(TSH levels according to the 2017 American Thyroid Association guidelines that recommended to keep TSH<2.5 in aTPO positive and TSH<4 for aTPO negative pregnant women).
Conclusions
aTPO can be frequently found in patients with positive aPL and they may be associated to abnormal TSH values during pregnancy. The rate of APO was not significantly different in aTPO positive patients as compared to negative ones; however, the influence of personalized prophylactic treatment must be acknowledged as a confounder.