The Association Between Antiphospholipid Antibodies and Adverse Pregnancy Outcomes: A Metaanalysis.
Bibliographic record
Abstract
Abstract BACKGROUND: The Sapporo criteria for the diagnosis of the antiphospholipid syndrome (APS) are based on the presence of antiphospholipid antibodies (APLA) and clinical criteria. Although pre-eclampsia, intra-uterine growth restriction (IUGR), late fetal loss and placental abruption, collectively termed “placenta mediated complications”, are recognized as clinical criteria for the APS, their association with APLA remains controversial. OBJECTIVE: This review was conducted to evaluate the association between APLA (anticardiolipin antibodies, lupus anticoagulant, anti B2 glycoprotein 1 antibodies) and placenta mediated complications in untreated women without autoimmune diseases. METHODS: We performed a systematic review of published case-control, cohort and cross sectional studies using MEDLINE (1975 to October week 2 2007), EMBASE 16 (1980 to 2007 week 42) and all EBM Reviews (3rd quarter of 2007). For eligible studies, the rates of adverse pregnancy outcomes were compared between patients with and without specific APLA. Pooled odds ratios with 95% CI were generated using random-effects models. RESULTS: Our search strategy identified 1204 potentially relevant studies. Twenty five were included in the final analysis. Results are outlined in table 1. CONCLUSION: The association between various APLA and pregnancy complications is for the most part weak and inconsistent. There is currently insufficient data to support a significant link between anti-B2 glycoprotein 1 antibodies and pregnancy morbidity. Caution should be used when establishing a diagnosis of APS based on the presence of any APLA, particularly anti-B2 glycoprotein 1 antibodies, in the setting of late pregnancy complications. Table 1 Association Between APLA and Adverse Pregnancy Outcomes Pre-eclampsia OR (95%CI) # studies / participants IUGR OR (95%CI) # studies / participants Placental abruption OR (95%CI) # studies / participants Late fetal loss OR (95%CI) # studies / participants LA: Lupus anticoagulant; aCL: Anticardiolipin antibodies; Anti-B2 GP1 antibodies: Anti-B2 glycoprotein 1 antibodies italic characters indicate statistically significant associations LA 2.88 (1.42, 5.87) 11 / 6085 3.51 (1.38, 8.93) 4 / 3232 0.78 (0.13, 4.80) 2 / 226 3.56 (0.12, 106.05) 3 / 3870 aCL (IgG/IgM) 1.71 (1.09, 2.70) 21 / 9722 2.31 (0.74, 7.17) 6 / 5753 1.35 (0.45, 4.02) 4 / 1274 3.86 (1.14, 13.07) 7 / 5963 aCL IgG 1.65 (0.84, 3.22) 15 / 3627 6.16 (2.50, 15.18) 2 / 1006 1.87 (0.21, 16.83) 2 / 500 10.06 (0.88, 114.96) 2 / 1006 aCL IgM 1.36 (0.93, 1.97) 13 / 5397 0.75 (0.19, 2.93) 2 / 3002 0.96 (0.24, 3.85) 2 / 500 1.37 (0.42, 4.46) 3 / 3212 anti- B2GP1 (IgG/IgM) 2.97 (0.47, 18.69) 4 / 2225 20.03 (4.59, 87.43) 1 / 1108 2.64 (0.14, 50.63) 1 / 510 6.74 (0.24, 191.23) 3 / 1828 anti- B2GP1 IgG 0.87 (0.38, 2.01) 2 / 607 N/A 0 / 0 N/A 0 / 0 0.52 (0.02, 11.02) 1 / 212 anti- B2GP1 IgM 0.37 (0.16, 0.85) 1 / 400 N/A 0 / 0 N/A 0 / 0 1.32 (0.24, 7.42) 1 / 210
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.034 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".