Effect of hypocomplementemia on perinatal outcomes of pregnancies with autoimmune disorders

Abstract

OBJECTIVE:

To demonstrate the effect of preconceptional complement levels on perinatal outcomes of pregnancies with autoimmune disorders.

METHODS:

Pregnant women with autoimmune disorders (autoimmune disease and/or autoimmune antibody positivity) who were screened for complement levels (C3 and C4) prior to their pregnancies were enrolled in a special antenatal care program. These patients were administered low-dose low-molecular-weight heparin (enoxaparine, 1 $\times$ 2000 Anti-XA IU/0.2 mL/day), low-dose salysilic acid (100 mg/day) and low-dose corticosteroid (methylprednisolone, 1 $\times$ 4 mg/day orally) as soon as their pregnancies were confirmed according to the institutional protocol. We have compared hypo- and normocomplement pregnancies with autoimmune disorders in terms of their obstetric and perinatal outcomes. We have also used Beksac Obstetric Index (BOI) which is “[living child $+$ ( $\pi$ /10)]/gravidity” for the comparison of their previous obstetric histories.

RESULTS:

Obstetric and neonatal outcomes showed no significant difference between hypocomplement patients ( $n=$ 38) and control group ( $n=$ 157) ( $p>$ 0.05). “Composite obstetric and perinatal adverse outcome” rates were 26.2% and 27.3% in study and control groups, respectively ( $p>$ 0.05). BOI was significantly lower in hypocomplement patients ( $p$ : 0.002). Then, we have classified hypocomplement patients into 3 subgroups according to the type of complement (C3, C4 or both). Comparison inbetween these groups revealed no statistical significance in any of the analyzed parameters ( $p>$ 0.05).

CONCLUSION:

Low complement levels in pregnant women with autoimmune disorders may be associated with gestational problems and poor obstetric history. Immunomodulatory treatment modalities such as ours may be beneficial for improving the obstetric and neonatal outcomes.