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 Deep Brain Stimulation Provides Sustained Relief for Severe Depression
19.03.2019 | Universitätsklinikum Freiburg

nachricht AI study of risk factors in type 1 diabetes
06.03.2019 | University of Gothenburg

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: New gene potentially involved in metastasis identified

Gene named after Roman goddess Minerva as immune cells get stuck in the fruit fly’s head

Cancers that display a specific combination of sugars, called T-antigen, are more likely to spread through the body and kill a patient. However, what regulates...

Im Focus: The taming of the light screw

DESY and MPSD scientists create high-order harmonics from solids with controlled polarization states, taking advantage of both crystal symmetry and attosecond electronic dynamics. The newly demonstrated technique might find intriguing applications in petahertz electronics and for spectroscopic studies of novel quantum materials.

The nonlinear process of high-order harmonic generation (HHG) in gases is one of the cornerstones of attosecond science (an attosecond is a billionth of a...

Im Focus: Magnetic micro-boats

Nano- and microtechnology are promising candidates not only for medical applications such as drug delivery but also for the creation of little robots or flexible integrated sensors. Scientists from the Max Planck Institute for Polymer Research (MPI-P) have created magnetic microparticles, with a newly developed method, that could pave the way for building micro-motors or guiding drugs in the human body to a target, like a tumor. The preparation of such structures as well as their remote-control can be regulated using magnetic fields and therefore can find application in an array of domains.

The magnetic properties of a material control how this material responds to the presence of a magnetic field. Iron oxide is the main component of rust but also...

Im Focus: Self-healing coating made of corn starch makes small scratches disappear through heat

Due to the special arrangement of its molecules, a new coating made of corn starch is able to repair small scratches by itself through heat: The cross-linking via ring-shaped molecules makes the material mobile, so that it compensates for the scratches and these disappear again.

Superficial micro-scratches on the car body or on other high-gloss surfaces are harmless, but annoying. Especially in the luxury segment such surfaces are...

Im Focus: Stellar cartography

The Potsdam Echelle Polarimetric and Spectroscopic Instrument (PEPSI) at the Large Binocular Telescope (LBT) in Arizona released its first image of the surface magnetic field of another star. In a paper in the European journal Astronomy & Astrophysics, the PEPSI team presents a Zeeman- Doppler-Image of the surface of the magnetically active star II Pegasi.

A special technique allows astronomers to resolve the surfaces of faraway stars. Those are otherwise only seen as point sources, even in the largest telescopes...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

International Modelica Conference with 330 visitors from 21 countries at OTH Regensburg

11.03.2019 | Event News

Selection Completed: 580 Young Scientists from 88 Countries at the Lindau Nobel Laureate Meeting

01.03.2019 | Event News

LightMAT 2019 – 3rd International Conference on Light Materials – Science and Technology

28.02.2019 | Event News

 
Latest News

Riveting,Screwing, Gluing in Aircraft Construction: Smart Human-Robot Teams Master Agile Production

26.03.2019 | Trade Fair News

Decoding the genomes of duckweeds: low mutation rates contribute to low genetic diversity

26.03.2019 | Life Sciences

Laser processing is a matter for the head – LZH at the Hannover Messe 2019

25.03.2019 | Trade Fair News

VideoLinks
Science & Research
Overview of more VideoLinks >>>