Screening for antiphospholipid antibodies in women with pregnancy complications.

We read with great interest the article by Bates et al 1 in an issue of CHEST (February 2012), in which the authors evaluate the evidence on the risk of pregnancy complications in women with thrombophilia. In this guideline article, the authors recommend screen ing for antiphospholipid antibodies in women with recurrent early pregnancy loss with a high level of evidence (Grade 1B). The antiphospholipid syndrome is an autoimmune condition characterized by vascular thromboses (arterial and/or venous) and/or pregnancy morbidity in the presence of antiphospholipid antibodies. The pregnancy morbidity includes one unexplained fetal death (later than 10 weeks’ gestation); three or more unexplained consecutive miscarriages (before 10 weeks’ gestation); or one or more premature births of a morphologically normal neo nate before the 34th week of gestation because of eclampsia, severe preeclampsia, or placental insuffi ciency. Evidence suggests that the fetal death Sapporo pregnancy morbidity criterion is the most specifi c, whereas the recurrent early abortion criterion may be the most sensitive, 2 being lupus anticoagulant the greatest predictor of fetal loss after 24 weeks’ gestation . 3 We suggest that there is strong evidence to recommend screen ing for antiphospholipid antibodies in women with late pregnancy loss and/or premature birth because of eclampsia, severe preeclampsia, or placental insuffi ciency.