Antiphospholipid Antibodies in Stillbirth

Abstract

Objective

To compare antiphospholipid antibodies in deliveries with and without stillbirth using a multicenter, population-based case-control study of stillbirths and live births.

Methods

Maternal sera were assayed for IgG and IgM anticardiolipin and anti-β ₂-glycoprotein-I antibodies. Assays were performed in 582 stillbirth deliveries and 1,547 live birth deliveries.

Results

Elevated levels of IgG anticardiolipin and IgG anti-β ₂-glycoprotein-I antibodies were associated with an approximate threefold increased odds of stillbirth; crude odds ratio (OR) 3.43 (95% confidence interval [CI] 1.79, 6.60) (3.8% versus 1.1%) and OR 3.17 (95% CI 1.30, 7.72) (1.9% versus 0.6%), respectively when all deliveries with stillbirth were compared with all deliveries with live birth. When the subset of stillbirths not associated with fetal anomalies or obstetric complications were compared with term live births, elevated IgG anticardiolipin antibodies were associated with stillbirth (5.0% versus 1.0%) (OR 5.30, 95% CI 2.39–11.76); IgG anti-β ₂-glycoprotein-I antibodies (1.9% versus 0.6%) had an OR of 3.00 (95% CI 1.01–8.90) and IgM anticardiolipin antibodies (6.0% versus 3.0%) had an OR of 2.03 (95% CI 1.09–3.76). Elevated levels of anticardiolipin and anti-β ₂-glycoprotein-I antibodies were associated with a threefold to fivefold increased odds of stillbirth.

Conclusions

Our data support consideration of testing for antiphospholipid antibodies in cases of otherwise unexplained stillbirth.