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Blood test identifies high-risk lupus pregnancies

First-trimester biomarkers reliable in spotting women who need greatest monitoring

Louise Prime

Wednesday, 30 September 2015

A first-trimester maternal blood test can reliably identify those women with systemic lupus erythematosus (SLE) who are at greatest risk of adverse pregnancy outcomes, allowing counselling and close monitoring to be targeted at them effectively, as well as allowing others to be reassured, research* has shown.

Women with lupus have an increased risk of adverse pregnancy outcomes including pre-eclampsia, placental insufficiency, foetal growth restriction, foetal death and miscarriage. Antiphospholipid syndrome (APL), which can occur with or without lupus, can damage the placenta and cause arterial and venous thromboses; more than a fifth of pregnancies in women with lupus APL have adverse outcomes.

US investigators followed 497 pregnant women who had lupus and/or APL, and 207 matched healthy controls, from 12 weeks’ gestation and for every month of pregnancy. They found that as early as 12-15 weeks’ gestation, assessment of changes in biomarkers – specifically circulating angiogenic factors that regulate development of the placenta and influence the health of blood vessels in the mother – can signal an increased risk for severe complications, including pre-eclampsia before 34 weeks’ gestation, foetal or neonatal death, or preterm delivery before 30 weeks, because of placental insufficiency.

Until now, most pregnant women with SLE and APL have undergone extensive antenatal evaluation, including serial ultrasound examinations and appointments with rheumatologists and obstetricians. But because this test had high negative predictive value – in more than 95% of pregnancies when the concentration of biomarkers measured in early pregnancy was normal, there were no serious complications – it could allow doctors to rule out severe complications in most women. This in turn would mean more appropriate antenatal care, saving healthcare costs and relieving the women’s anxiety.

Writing in the American Journal of Obstetrics & Gynecology, the study authors said: “Pregnancies in patients with SLE and/or APL can result in poor outcomes, even when disease activity is low, and baseline clinical features and laboratory tests have only modest ability to identify patients at highest risk for adverse pregnancy outcomes. Our study is the first to demonstrate, in a prospective cohort, the usefulness of angiogenic biomarkers measured as early as the 12th week of pregnancy, in combination with clinical criteria, to identify patients with SLE and/or APL at risk of severe adverse pregnancy outcomes.”

* Kim MY, Buyon JP, Guerra MM et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: results of the PROMISSE study. American Journal of Obstetrics & Gynecology, published online in advance of Volume 214, Issue 1 (January 2016). DOI: 10.1016/j.ajog.2015.09.066

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