Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study sheds light on pregnancy complications and overturns common belief

04.07.2012
A study led by Hospital for Special Surgery researchers has demonstrated that women who have a specific type of antibody that interferes with blood vessel function are at risk for adverse pregnancy outcomes and that other antibodies in the same family thought to cause pregnancy complications do not put women at risk.

The researchers say that many doctors may be unnecessarily treating some pregnant women who have antiphospholipid antibodies (aPLs) with anticoagulants, such as expensive heparin injections, which can cause bleeding and bone loss. The multicenter study appears in the July 2012 issue of the journal Arthritis & Rheumatism.

"This paper identifies people who are at risk for pregnancy loss and, more importantly, those who are not at risk and who therefore do not need to be treated," said Michael Lockshin, M.D., director, Barbara Volcker Center for Women and Rheumatic Disease, and co-director, Mary Kirkland Center for Lupus Research at Hospital for Special Surgery (HSS), New York City, and lead author of the study.

Antiphospholipid antibodies interfere with phospholipids, a type of fat found in all living cells and cell membranes, including blood cells and the lining of blood vessels. Patients with these antibodies are at risk for blood clots, stroke, and pregnancy complications, but some patients with these antibodies can be completely healthy. "Phospholipids are highly exposed in the placenta, and as a result antiphospholipid antibodies concentrate there," said Jane Salmon, M.D., the study's senior author and Collette Kean Research Chair and co-director, Mary Kirkland Center for Lupus Research at HSS. "When antibodies are deposited in a person's tissues, inflammation is initiated leading to organ damage." And this is a mechanism for pregnancy complications.

Women who have recurrent pregnancy loss are commonly tested for the presence of aPLs, and up to 15% are positive. Most patients who test positive are treated with anticoagulants. Currently, there are no standards regarding which aPLs doctors test for to assess risk (there are three main ones) and interlaboratory consistency of results is poor.

The new study is the first clinical research publication of the PROMISSE study, an ongoing multicenter, prospective clinical trial comparing the pregnancies of women with aPL, lupus, both aPL and lupus, and healthy controls. Between 20% and 35% of patients with lupus and aPL have pregnancy complications and the study is attempting to identify which patients are at risk.

"The identification of biomarkers that identify patients at high risk will allow us to select a subset of patients who we can consider in an interventional trial," said Dr. Salmon, the principal investigator of PROMISSE. This PROMISSE study, which involves over 700 patients from nine centers in North America, is funded by the National Institute of Arthritis, Musculoskeletal and Skin Diseases of the National Institutes of Health. A strength of PROMISSE is that all aPL tests were sent to core laboratories, eliminating interlaboratory variability.

The current analysis focused on 144 patients who had aPLs, of whom 28 had adverse pregnancy outcomes. A control group, 159 healthy pregnant women, was tested parallel to the group with aPLs. Controls were selected among women with no known illness, no prior fetal loss, no more than one miscarriage and at least one successful pregnancy.

The study examined the association between adverse pregnancy outcome and the presence of three different aPLs: lupus anticoagulant [LAC], anticardiolipin antibody [aCL] and antibody to â2 glycoprotein I. An adverse pregnancy outcome was defined as otherwise unexplained fetal death after 12 weeks, neonatal death prior to discharge that was associated with complications of prematurity, preterm delivery prior to 34 weeks because of gestational hypertension, preeclampsia or placental insufficiency, and birthing a child that was small for its gestational age.

The researchers found that LAC was the strongest predictor of an adverse pregnancy outcome; 39% of patients with LAC had an adverse outcome compared to 3% who did not have LAC (P

Anticoagulant treatments are currently used for many women with aPLs, but identifying who to treat is not clear and this treatment is often ineffective. "Although many patients with aPLs are treated with heparin, pregnancy outcomes are still disappointing. We need better therapies," said Dr. Salmon. "This study will allow us to identify subsets of patients with the highest risk in whom to test new approaches and new drugs."

Dr. Salmon's studies in mice with aPL have shown that blocking inflammatory pathways can prevent miscarriages, growth restriction and preeclampsia. Further studies on samples from PROMISSE patients, followed by interventional trials will hopefully shed light on whether this therapeutic approach will be effective in pregnant women with aPLs and/or lupus.

Other investigators also involved in the study include Lisa Sammaritano, M.D., from Hospital for Special Surgery; D. Ware Branch, M.D., University of Utah Sciences Center and Intermountain Heatlhcare, Salt Lake City; Jill Buyon, M.D., New York University School of Medicine; Carl A. Laskin, M.D., University of Toronto, Toronto; Joan Merrill, M.D., Oklahoma Medical Research Foundation and the University of Oklahoma Sciences Center; Michelle Petri, M.D., MPH, Johns Hopkins University School of Medicine; T Flint Porter, M.D., University of Utah Health Sciences Center and Intermountain Healthcare, Salt Lake City; and Mary Stephenson, M.D., University of Chicago.

About Hospital for Special Surgery

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 2 in rheumatology, No. 19 in neurology, and No. 16 in geriatrics by U.S.News & World Report (2011-12), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center three consecutive times. HSS has one of the lowest infection rates in the country. From 2007 to 2011, HSS has been a recipient of the HealthGrades Joint Replacement Excellence Award. HSS is a member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

For more information contact:

Phyllis Fisher
212-606-1197
FisherP@hss.edu
Tracy Hickenbottom
212-606-1197
HickenbottomT@hss.edu

Phyllis Fisher | EurekAlert!
Further information:
http://www.hss.edu

More articles from Studies and Analyses:

nachricht Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Terahertz spectroscopy goes nano

20.10.2017 | Information Technology

Strange but true: Turning a material upside down can sometimes make it softer

20.10.2017 | Materials Sciences

NRL clarifies valley polarization for electronic and optoelectronic technologies

20.10.2017 | Interdisciplinary Research

VideoLinks
B2B-VideoLinks
More VideoLinks >>>