RESEARCHERS have found that antiphospholipid antibodies are associated with a significantly higher risk of adverse pregnancy outcomes in women with systemic lupus erythematosus, with certain antibody combinations carrying a substantially higher risk than others.
Antiphospholipid Antibodies and Pregnancy Risk in Lupus
Systemic lupus erythematosus has predominantly affected women of childbearing age and has often been associated with adverse pregnancy outcomes. Antiphospholipid antibodies have been recognised as risk factors for adverse pregnancy outcomes in the general population, and their prevalence has remained higher in patients with lupus, yet the impact of different antibody profiles had not been systematically investigated.
Single-Centre Cohort Study in China
Researchers analysed data from a single-centre cohort of patients with systemic lupus erythematosus in China, measuring antiphospholipid antibody profiles: anticardiolipin antibodies, anti-β2 glycoprotein I antibodies, and lupus anticoagulant. Adverse pregnancy outcomes were defined as prefetal or fetal death, and severe pre-eclampsia or placental insufficiency before 34 weeks of gestation. The study included 441 singleton pregnancies among 410 patients with lupus.
Antibody Positivity Linked to Higher Rates of Poor Outcomes
Of the 441 pregnancies, 78 (17.9%) were positive for antiphospholipid antibodies, 71 (16.1%) resulted in adverse outcomes, and 391 (88.7%) resulted in a live birth. Positive antibodies were associated with more frequent adverse outcomes (29.5% vs 13.2%; p=0.002), higher risk of fetal death (p=0.021), and failure of live birth (p=0.011).
Anticardiolipin IgG (p=0.003), anti-β2 glycoprotein I IgG (p=0.020), and lupus anticoagulant (p=0.002) were each associated with significantly increased risk, whereas the corresponding IgM antibodies were not. Lupus anticoagulant combined with IgG isotypes of anticardiolipin and/or anti-β2 glycoprotein I emerged as the highest-risk profile (p=0.002), while other combinations showed no significant association (p=0.128).
Implications for Risk Stratification in Lupus Pregnancy Care
These findings have demonstrated the adverse effects of antiphospholipid antibodies on pregnancy outcomes in patients with lupus, with different antibody profiles showing distinct impacts. As this was a retrospective cohort study, causality cannot be established. The authors have highlighted the importance of risk stratification in this population, with particular focus on patients positive for lupus anticoagulant combined with IgG isotypes of anticardiolipin and/or anti-β2 glycoprotein I antibodies.
Reference
Zhang X et al. Prognostic value of antiphospholipid antibodies in pregnancy outcomes in systemic lupus erythematosus. RMD Open. 2026;12:e006870.
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