Early-Onset Severe Hypertensive Disease in Pregnancy: Who Is Screened for Antiphospholipid Syndrome? [19H]

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Abstract

INTRODUCTION:

Although a history of early preterm delivery (PTD) due to severe hypertensive disease of pregnancy is a clinical criterion for diagnosing antiphospholipid syndrome (APS), there is currently no consensus regarding screening for APS in these women. Therefore, our aim was to determine frequency of APS screening in this population and to identify characteristics that affect likelihood of screening.

METHODS:

Retrospective cohort study of iatrogenic deliveries before 34 weeks for preeclampsia with severe features, superimposed preeclampsia with severe features, HELLP syndrome, or eclampsia, at a single institution from 2012 to 2017. Charts were reviewed for APS testing, as well as gestational age (GA) at delivery, fetal complications, and severity of maternal disease. Fisher exact test and chi-squared tests were used for univariate analyses of categorical variables, rank sum for univariate analyses of continuous variables, and multivariate logistic regression for adjusted odds ratios.

RESULTS:

Among 133 cases, 19 (14.3%) received APS screening. Compared to unscreened patients, screened patients were older (32 vs 29 years, P=.04), delivered earlier (28.9 vs 31.7 weeks, P <.001), and had a higher rate of intrauterine fetal demise (15.8% vs 1.8%, P =.021). In multivariate analysis, each additional week GA was associated with a 25% decrease in the odds of screening (aOR 0.75, P <.01).

CONCLUSION:

Among women with severe hypertensive disease requiring PTD, APS screening was more likely in those with earlier PTD or intrauterine fetal demise. These patients have contraceptive, obstetrical, and long-term risks that require deviations from typical patient counseling, which may prompt changes in screening recommendations.

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