This prospective study followed 60 pregnant women (33 aPL-positive, 27 aPL-negative controls with SLE/RA/UCTD) to evaluate whether non-classification aPL markers (anti-PS/PT IgG/IgM, anti-β2GPI-DI IgG) and complement pathway activity (classical, alternative, lectin) could predict preterm delivery (PTD) across 231 specimens collected during pregnancy and postpartum.
PTD occurred in 21% of aPL-positive vs. 15% of aPL-negative women; aPL-positive PTD women had significantly higher anti-PS/PT IgG/IgM titers (p<0.05) at nearly all timepoints and significantly lower lectin pathway (LP) activity vs. aPL-negative PTD women (p<0.05); LP activity and anti-PS/PT titers measured in the first trimester both correlated significantly with gestational week at delivery (p<0.05).
Small sample size (n=60 total; only ~7 aPL-positive women experienced PTD), limiting statistical power and generalizability. The aPL-negative control group was heterogeneous (SLE, RA, UCTD), making direct comparisons complex. Causality between LP activity, anti-PS/PT, and PTD cannot be established from this observational design.
Consider measuring anti-PS/PT IgG/IgM and lectin pathway activity in the first trimester for aPL-positive pregnant women, as elevated anti-PS/PT titers and reduced LP activity may serve as early warning signs for preterm delivery. These markers are not yet part of standard APS classification criteria but could help risk-stratify this high-risk obstetric population.
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