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Significance of Anti-Phosphatidylethanolamine Antibodies in the Pathogenesis of Recurrent Pregnancy Loss

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Abstract

Anti-phosphatidylethanolamine antibody (aPE), an anti-phospholipid autoantibody (aPL), has been proposed as a factor in recurrent pregnancy loss (RPL). However, conflicting views exist on the pathogenicity of RPL, and aPE has not yet been included in the classification criteria for antiphospholipid syndrome (APS). Here, we aimed to determine the clinical importance of examining aPE. aPE (IgG, IgM) was measured in 1705 patients with a history of RPL and re-examined after a 12-week interval in patients who tested positive. Persistent positive patients were administered low-dose aspirin during the subsequent pregnancy and clinical outcomes depending on the presence, type, and persistence of aPE were evaluated. Among the patients positive for aPE IgG and aPE IgM in the first examination (n = 117; 6.87%, and n = 235; 13.6%, respectively), 31.5% and 37.6% were negative upon re-examination, respectively. Moreover, among the cases with known pregnancy outcome, the miscarriage rate in the cumulative positive aPE group was 32.6% (29/89), which did not differ significantly from that of the aPE negative group (27.7%; 80/209; P = 0.178). Alternatively, the miscarriage rate in the persistently positive group was 40.7% (22/54), which was significantly higher than that in the transient positive group, 20.0% (7/35) (P = 0.041). Particularly, this difference become more significant when focusing on aPE IgM, 46.9% (15/32) in the persistent, compared with 16.7% (4/24) in the transient positive group (P = 0.024). aPE IgM is suggested to serve as a pathogenic aPL together with anti-cardiolipin antibodies and lupus anticoagulants, particularly if these factors persist over an extended period of time.

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Data Availability

Data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was supported in part by Japan Society for the Promotion of Science (JSPS; JSPS KAKENHI, Grant Number 25462578), and was supported in part by the Project for Baby and Infant Research of Health and Development to Adolescent and Young Adult from Japan Agency for Medical Research and Development, AMED.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Mirei Yonezawa, Yoshimitsu Kuwabara, Shuichi Ono, Nozomi Ouchi, Tomoko Ichikawa & Toshiyuki Takeshita

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  1. Mirei Yonezawa
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  2. Yoshimitsu Kuwabara
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  3. Shuichi Ono
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  4. Nozomi Ouchi
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  5. Tomoko Ichikawa
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  6. Toshiyuki Takeshita
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Corresponding author

Correspondence to Yoshimitsu Kuwabara.

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Study protocols were approved by the Medical Ethics Committee of Nippon Medical School hospital.

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Written consent for publication was obtained from all participants in this study.

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Yonezawa, M., Kuwabara, Y., Ono, S. et al. Significance of Anti-Phosphatidylethanolamine Antibodies in the Pathogenesis of Recurrent Pregnancy Loss. Reprod. Sci. 27, 1888–1893 (2020). https://doi.org/10.1007/s43032-020-00208-4

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  • DOI: https://doi.org/10.1007/s43032-020-00208-4

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