Maternal anti-protein Z antibodies in pregnancies complicated by pre-eclampsia, SGA and fetal death

Offer Erez, Roberto Romero, Edi Vaisbuch, Shali Mazaki-Tovi, Juan Pedro Kusanovic, Tinnakorn Chaiworapongsa, Nandor Gabor Than, Francesca Gotsch, Chong Jai Kim, Pooja Mittal, Samuel Edwin, Percy Pacora, Sun Kwon Kim, Lami Yeo, Moshe Mazor, Sonia S. Hassan

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Objective. Low maternal plasma protein Z PZ concentrations were reported in patients with pre-eclampsia PE, a small for gestational age SGA neonate, and a fetal demise FD. Anti-protein Z antibodies APZ-AB have been proposed as a possible underlying mechanism leading to low plasma PZ concentrations. The objective of this study was to determine the maternal plasma concentration of APZ-AB in women with a normal pregnancy, and patients with PE, an SGA neonate or a FD. Study design. A cross-sectional study included women in the following groups: 1 non-pregnant women n 45; and pregnant women with: 2 normal pregnancies n 70; 3 PE n 123; 4 SGA neonates n 51; and 5 a FD n 51. Plasma concentrations of anti-protein Z IgM and IgG antibodies were measured by ELISA. Elevated APZ-AB was defined as >75th, 90th and 95th percentile of the normal pregnancy group. Non-parametric statistics were used for analyses. Results.1 Patients with an SGA neonate had a higher median maternal plasma IgG APZ-AB concentration than women with normal pregnancies p < 0.001, and patients with PE p < 0.001 or with a FD p 0.001. 2 The proportion of patients with a maternal plasma IgM APZ-AB concentration >90th percentile was higher in the SGA group than in the PE group p 0.01. 3 Patients with PE maternal plasma IgM APZ-AB concentration >90th percentile had a higher rate of villous thrombosis p 0.03 and persistent muscularisation of basal plate arteries p 0.01 than those with IgM APZ-AB concentration <90th percentile; and 5 Patients with FD and maternal plasma IgM APZ-AB concentration >90th percentile had a higher rate of umbilical phlebitis and arteritis than those with IgM APZ-AB concentration <90th percentile p 0.003. Conclusions.1 Patients with SGA neonates have a higher median plasma concentration of IgG APZ-AB than normal pregnant women, or patients with PE or FD; and 2 maternal plasma IgM APZ-AB concentration >90th percentile was associated with vascular placental lesions in patients with PE, but not in those with an SGA neonate, suggesting that in a subset of patients, these antibodies can be associated with abnormal placentation and pregnancy complications.

Original languageEnglish
Pages (from-to)662-671
Number of pages10
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume22
Issue number8
DOIs
StatePublished - 9 Nov 2009
Externally publishedYes

Keywords

  • Antiphospholipid
  • Autoantibodies
  • Hypertension
  • Placenta
  • Pregnancy
  • Vasculitis protein Z

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