Placental Abnormalities in Systemic Lupus Erythematosus: Novel Markers of Adverse Pregnancy Outcomes
Bibliographic record
Abstract
Objectives Placenta-mediated adverse pregnancy outcomes (APO) are a huge concern in SLE. Recent efforts to understand APO include the establishment of the 2016 Amsterdam classification criteria,[1] developed to standardize placental pathology evaluation. No study to date evaluated the Amsterdam criteria in SLE. Using the prospective “Lupus prEGnAnCY (LEGACY)” biobank, we assessed the relationship between placental abnormalities, lupus anticoagulant (LAC), and APO, applying the Amsterdam criteria. Methods LEGACY is a prospective cohort enrolling SLE pregnancies (before the 17th gestational week). Relevant information is collected at each trimester and/or end-of-pregnancy visits. We evaluated pregnancies delivered beyond 17 weeks at the Montreal site. Placental pathology was defined as abnormal if fulfilling at least 1of the 4 main Amsterdam classification subtypes: (1) maternal vascular malperfusion, (2) fetal vascular malperfusion, (3) acute chorioamnionitis, and/or (4) villitis of unknown etiology. Pregnancies with and without abnormal pathology were further characterized based on presence of LAC and APO (ie, stillbirth, placental insufficiency, gestational hypertension, preeclampsia, small-for-gestational age neonate <5%). Results Of 44 LEGACY pregnancies delivered (beyond 17 weeks), 32 (73%) had placental pathology available. Among these 32, 15 (47%) had abnormal pathology. Of those with abnormal pathology, 6/15 (40%) had maternal vascular malperfusion, 5/15 (33%) acute chorioamnionitis, 4/15 (27%) villitis of unknown etiology, and 1/15 (7%) fetal vascular malperfusion. Mean gestational age at delivery was substantially lower in pregnancies with abnormal pathology [mean 33.7 weeks, standard deviation (SD) 6.8] versus those with normal pathology (mean 37.8 weeks, SD 1.7), with a difference in mean gestational age of −4.1 weeks (95% CI −0.6, −7.6). LAC was more frequent in pregnancies with abnormal pathology (4/15; 27%) as opposed to pregnancies with normal pathology (2/17; 12%). APO occurred in 8/15 (53%) pregnancies with abnormal pathology (including 3 with early preterm preeclampsia <34 weeks) as opposed to 7/17 (41%) pregnancies with normal pathology (none with early preterm preeclampsia). Maternal vascular malperfusion was strongly associated with APO (odds ratio 8.1; 95% CI 0.8, 83.7), although the CI included the null. Conclusion In this cross-sectional analysis, SLE pregnancies with abnormal placenta pathology, particularly maternal vascular malperfusion, experienced shorter gestation and more severe placenta-mediated APO, including early preterm preeclampsia. Future studies will aim to expand the sample and investigate if placental abnormalities in 1 pregnancy helps predict APO in subsequent pregnancies. [1.] Khong T. Arch Pathol Lab Med 2016;140(7):698-713. Best Abstract on Basic Science Research by a Trainee Award. Supported by a CIORA grant
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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 | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".