ArticleBMC pregnancy and childbirth2026
Clinical features of non-criteria obstetric antiphospholipid syndrome: a retrospective cohort study on antibody-based risk classification and pregnancy outcomes.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo characterize patients with non-criteria obstetric antiphospholipid syndrome (NOAPS) and to evaluate how distinct antiphospholipid antibody (aPL) profiles relate to adverse gestational outcomes.
methodsWe retrospectively analyzed 350 women diagnosed from November 2021 to July 2024. Collected information included demographic characteristics, aPL stratification, anticardiolipin antibodies (ACA), anti-β2 glycoprotein I antibodies (aβ2-GPIs), lupus anticoagulant (LA), treatment regimens, therapy duration, and obstetric outcomes (such as recurrent miscarriage, hypertensive disorders, premature delivery, and intrauterine growth restriction). Participants were grouped into high-, medium-, and low-risk categories according to aPL stratification. Propensity score matching (PSM) was conducted in R software, and maternal-fetal outcomes were compared across the three strata. Logistic regression was applied to assess the impact of aPL profiles, and correlation analyses plus heatmaps were used to visualize associations.
resultsRecurrent miscarriage was most frequent in high-risk women (50.56% vs. 13.48% in low-risk, P < 0.001). The incidence of preeclampsia was 38.20% in the high-risk group compared with 16.85% and 20.23% in the medium- and low-risk groups (P = 0.002). Preterm birth (26.97%) and fetal growth restriction (23.60%) were also significantly more common in the high-risk cohort (both P < 0.01). Fetal distress occurred in 49.44% of high-risk patients, exceeding rates in the medium-risk (32.58%) and low-risk (15.73%) groups (both P < 0.01). Multivariable regression indicated that high-risk profiles were strongly linked to poor maternal and neonatal outcomes (Maternal: OR = 5.013, 95% CI 2.683-9.613; Neonatal: OR = 12.302, 95% CI 6.092-26.283). aPL stratification independently predicted placental abruption, miscarriage, preeclampsia, premature birth, growth restriction, and fetal distress (OR = 1.470-6.938). LA was identified as a predictor of maternal venous thrombosis (OR = 17.556, 95% CI 1.541-200.068), while ACA contributed to preeclampsia risk (OR = 1.778, 95% CI 1.283-2.465). Elevated ACA titers and positive aβ2-GPI results were significant for fetal distress (OR = 1.040 and 1.881).
conclusionIn NOAPS patients, risk stratification based on aPL antibody types, titers, and combination patterns can effectively predict adverse maternal-neonatal pregnancy outcomes. High-risk patients often need prompt, intensive anticoagulant therapy together with coordinated multidisciplinary surveillance.
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