Bundhun PK, et al. - Researchers performed a systematic comparison of arterial/venous thrombosis, fetal loss and stillbirth in pregnant women with systemic lupus erythematosus (SLE), primary anti-phospholipid syndrome (PAPS) and secondary anti-phospholipid syndrome (SAPS). On searching online databases for relevant publications comparing SLE with PAPS and/or SAPS in pregnancy, they included 941 pregnant women: 556 were candidates of SLE; 200 were candidates of PAPS; and 185 were candidates of SAPS. In comparison to SLE, PAPS and SAPS were noted to be correlated with significantly higher arterial/venous thrombosis, fetal loss, and stillbirth. However, PAPS and SAPS were not observed to differ significantly.

Methods

• Careful search of online databases was performed for relevant publications comparing SLE with PAPS and/or SAPS in pregnancy.
• The studies were included if: they compared SLE with APS [SLE vs PAPS or SLE vs SAPS or SLE vs PAPS and SAPS respectively] in pregnant women; and they reported specific adverse outcomes as their clinical endpoints including arterial/venous thrombosis, fetal loss and stillbirth.
• Researchers used risk ratios (RR) with 95% confidence intervals (CIs) as statistical parameters.
• They carried out the analysis by the RevMan 5.3 software.

Results

• Researchers included 941 pregnant women: 556 were candidates of SLE; 200 were candidates of PAPS; and 185 were candidates of SAPS.
• A significantly higher risk of fetal loss was observed in association with APS (RR: 4.49, 95% CI: 2.09–9.64; P=0.0001).
• Furthermore, significantly increased stillbirth and arterial/venous thrombosis were observed with APS (RR: 6.65, 95% CI: 2.14–20.60; P=0.001) and (RR: 3.95, 95% CI: 1.28–12.16; P=0.02) respectively.
• On comparing patients with PAPS with patients who suffered from SLE alone, the former still showed significantly higher fetal loss and arterial/venous thrombosis.
• Arterial/venous thrombosis, stillbirth and fetal loss were still significantly higher with SAPS when SAPS were compared with SLE (without anti-phospholipid antibodies).
• However, they identified no marked difference between PAPS and SAPS in terms of arterial/venous thrombosis and fetal loss.