Comparative study between obstetric antiphospholipid syndrome and obstetric morbidity related with antiphospholipid antibodies

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HR: hazard ratio; 95% CI: 95% confidence interval; LL: lower limit of the 95% confidence interval; UL: upper limit of the 95% confidence interval." ] ] ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "Òscar Miró, Patricia Javaloyes, Víctor Gil, Javier Jacob, Pablo Herrero-Puente, Francisco Javier Martín-Sánchez, Eva Salvo, Héctor Alonso, María Ángeles Juan Gómez, John Parissis, Pere Llorens" "autores" => array:12 [ 0 => array:2 [ "nombre" => "Òscar" "apellidos" => "Miró" ] 1 => array:2 [ "nombre" => "Patricia" "apellidos" => "Javaloyes" ] 2 => array:2 [ "nombre" => "Víctor" "apellidos" => "Gil" ] 3 => array:2 [ "nombre" => "Javier" "apellidos" => "Jacob" ] 4 => array:2 [ "nombre" => "Pablo" "apellidos" => "Herrero-Puente" ] 5 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" ] 6 => array:2 [ "nombre" => "Eva" "apellidos" => "Salvo" ] 7 => array:2 [ "nombre" => "Héctor" "apellidos" => "Alonso" ] 8 => array:2 [ "nombre" => "María Ángeles" "apellidos" => "Juan Gómez" ] 9 => array:2 [ "nombre" => "John" "apellidos" => "Parissis" ] 10 => array:2 [ "nombre" => "Pere" "apellidos" => "Llorens" ] 11 => array:1 [ "colaborador" => "on behalf of the grupo de investigación ICA-SEMES" ] ] ] 1 => array:2 [ "autoresLista" => "Cristina Gil Marta Fuentes, Manuel Garrido, Pablo Garmila, Esther Rodríguez Adrada, Guillermo Llopis Garcia, Rosa Escoda, Carolina Xipell, Carolina Sanchez, Josep M. 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[ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775317309065?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061830305X?idApp=UINPBA00004N" "url" => "/23870206/0000015100000006/v1_201810180619/S238702061830305X/v1_201810180619/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Comparative study between obstetric antiphospholipid syndrome and obstetric morbidity related with antiphospholipid antibodies" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "215" "paginaFinal" => "222" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jaume Alijotas-Reig, Enrique Esteve-Valverde, Raquel Ferrer-Oliveras, Elisa LLurba, Amelia Ruffatti, Angela Tincani, Elmina Lefkou, Mª Tiziana Bertero, Gerard Espinosa, Sara de Carolis, Patrizia Rovere-Querini, Krista Lundelin, Elisa Picardo, Arsene Mekinian" "autores" => array:15 [ 0 => array:4 [ "nombre" => "Jaume" "apellidos" => "Alijotas-Reig" "email" => array:2 [ 0 => "jalijotas@vhebron.net" 1 => "16297jar@comb.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Enrique" "apellidos" => "Esteve-Valverde" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Raquel" "apellidos" => "Ferrer-Oliveras" "email" => array:1 [ 0 => "raquelfo22@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "Elisa" "apellidos" => "LLurba" "referencia" => array:1 [ 0 => array:2 [ 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array:3 [ "nombre" => "Patrizia" "apellidos" => "Rovere-Querini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "k" "identificador" => "aff0055" ] ] ] 11 => array:3 [ "nombre" => "Krista" "apellidos" => "Lundelin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "l" "identificador" => "aff0060" ] ] ] 12 => array:3 [ "nombre" => "Elisa" "apellidos" => "Picardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "m" "identificador" => "aff0065" ] ] ] 13 => array:3 [ "nombre" => "Arsene" "apellidos" => "Mekinian" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "n" "identificador" => "aff0070" ] ] ] 14 => array:1 [ "colaborador" => "for the EUROAPS Study Group" ] ] "afiliaciones" => array:14 [ 0 => array:3 [ "entidad" => "Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d tm)Hebron University Hospital, Department of Medicine, Universitat Autonoma, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Internal Medicine Department, Althaia Healthcare Network of Manresa, Rheumatology Unit, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Obstetrics and Gynaecology Department, High Risk Unit, Vall d tm)Hebron University Hospital, Universitat Autonoma, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Obstetrics and Gynaecology Department, High Risk Unit, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Rheumatology Unit, Department of Clinical and Experimental Medicine Azienda Ospedaliera, University of Padua, Padua, Italy" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Rheumatology and Clinical Immunology Unit, Ospedale Civile, Brescia, Italy" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Haematology Unit, Hippokration Hospital of Thessaloniki, Greece" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Department of Clinical Immunology, A.O. Mauriziano-Umberto I, Turin, Italy" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Systemic Autoimmune Diseases Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Department of Gynaecology, Gemmeli Hospital, Catholic University, Roma, Italy" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Scuola di Specializzazione in Allergologia e Immunolofia Clinica, U.O. Medicina ad indrizzo Immunlogico Clinico-Ospedale San Raffaele, Milano, Lab, Autoimminità e inflammazione vascolare • San Raffaele DIBIT, Milano, Italy" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Internal Medicine Department, Hospital Universitario La Paz, Universidad Autònoma, Madrid, Spain" "etiqueta" => "l" "identificador" => "aff0060" ] 12 => array:3 [ "entidad" => "Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy" "etiqueta" => "m" "identificador" => "aff0065" ] 13 => array:3 [ "entidad" => "AP-HP, Hôpital Saint-Antoine, service de mèc)decine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universitèc)s, UPMC Univ Paris 06, F-75012, Paris, France" "etiqueta" => "n" "identificador" => "aff0070" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio comparativo entre síndrome antifisfolipídico obstèc)trico y morbilidad obstèc)trica relacionada con anticuerpos antifosfolípido" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2788 "Ancho" => 2018 "Tamanyo" => 519630 ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of patients in the two OMAPS subgroups." ] ] ] "textoCompleto" => "Background and objectivesThe antiphospholipid syndrome (APS) is an autoimmune systemic disorder characterised by an increased risk of vascular thrombosis and/or pregnancy morbidity, both associated with persistently • positive antiphospholipid/anticofactor antibody (aPL) tests according to the currently accepted Sydney criteria.<a class="elsevierStyleCrossRef" href="#bib0140">1</a> Thus, for APS diagnosis, at least one clinical criterion and one laboratory criterion are needed. APS is believed to be related to activation of the clot cascade with further thrombosis. Cases with poor obstetric outcomes, mainly recurrent first trimester miscarriage, foetal losses, stillbirth, early and severe preeclampsia leading to a preterm birth, but without a history of thrombosis, are known to have obstetric antiphospholipid syndrome (OAPS).<a class="elsevierStyleCrossRef" href="#bib0145">2</a> Although no complete agreement exists, there is evidence that laboratory markers, immunopathological pathways, treatment response, maternal complications and long-term follow-up may differ from those observed in APS outside the context of pregnancy.<a class="elsevierStyleCrossRefs" href="#bib0150">3,4</a>Consensus on the classification criteria for APS/OAPS permitted clinicians to standardise patient groups, but also generated controversy. In the last decade, a wide array of “non-criteria” obstetric morbidities and diverse non-classical aPL, low titres of accepted aPL, or other isotypes such as IgA, have been increasingly proposed.<a class="elsevierStyleCrossRefs" href="#bib0160">5,6</a> Women with pregnancy complications highly suggestive of OAPS but with persistently low titres for aPL, and those with accepted laboratory aPL criteria but not presenting full obstetric morbidity criteria • e.g. two recurrent miscarriages or placental vascular insufficiency over 34 weeks of gestation • are classified as incomplete OAPS.<a class="elsevierStyleCrossRefs" href="#bib0170">7,8</a> In addition, there is increasing discussion as to whether clinical cases with persistently negative titres for classical or non-classical aPL should be known as seronegative APS.<a class="elsevierStyleCrossRefs" href="#bib0180">9,10</a> Several published manuscripts stressed the contrariness of both incomplete and seronegative APS.<a class="elsevierStyleCrossRefs" href="#bib0170">7,11</a> Obviously, this raised practical clinical concerns regarding the classification and management of these women. Few studies have reported that women with persistent low-titre aPL positivity have obstetric outcomes comparable to the general population; thus, they may have good obstetric outcomes with or without treatment.<a class="elsevierStyleCrossRefs" href="#bib0195">12,13</a> By contrast, a recent study showed that anticardiolipin antibody (aCL) and anti-β2glycoprotein-I antibody (anti-β2GPI) low-positivity titres accurately identify women with aPL-related pregnancy complications.<a class="elsevierStyleCrossRefs" href="#bib0175">8,14•16</a> Given these considerations, some authors have claimed that the current diagnostic criteria are too restrictive and of limited use for clinical purposes, and have suggested redefining OAPS<a class="elsevierStyleCrossRefs" href="#bib0175">8,15,17•19</a>; Thus, some women could be underdiagnosed • false-negative diagnosis • with further foetal maternal complications.In 2014, the 14th International Congress on Antiphospholipid Antibodies Task Force Report on Obstetric APS concluded there is a paucity of data on several OAPS-related concerns and that new information should be obtained, mainly through randomised clinical trials and large series of patients recruited from multicentre registries. Moreover, they exposed the growing controversy on the clinical meaning of low titres of aPLs in pregnancy morbidity.<a class="elsevierStyleCrossRef" href="#bib0235">20</a>Thus, and within the EUROAPS project framework, we decided to refer to this incomplete OAPS group as Obstetric Morbidity related to the Antiphospholipid Antibodies • OMAPS group. Herein, we present the results of the OMAPS group in terms of obstetric morbidity, foetal and maternal outcomes, laboratory results, treatment rates and live birth rates, compared with those of OAPS to shed some light on this matter, and provide further reasons for continuing to study this still debatable APS subset.Materials and methodsPatientsOwing to the wide clinical spectrum of APS and strong evidence of the existence of different aPL-mediated pathogenic mechanisms between classical and obstetric forms of the syndrome, it was considered useful to create a single, homogeneous database in a multicentre European Registry where physicians could send, consult or insert patient data to facilitate and further understanding of several existing gaps associated with aPL-related obstetric syndromes, both in women fulfilling the Sydney criteria and those who did not.From June 2010, the ad-hoc website and database have been accessible and ongoing. Since then, patient data have been included systematically, both retrospectively and prospectively, as stated previously [<a id="intr0005" class="elsevierStyleInterRef" href="http://www.euroaps.org/">www.euroaps.org</a>] and are now accessible at: [<a id="intr0010" class="elsevierStyleInterRef" href="https://euroaps.wordpress.com/">https://euroaps.wordpress.com</a>]. All information regarding this project can also be found on the website.Study designEleven tertiary referral centres at universities in five European countries are participating in the Registry. Staffs at all centres are experienced in the management of patients with APS/OAPS. To date, the cohort has consisted of 338 cases; 247 met the proposed Sydney classification criteria (OAPS group) and 91 did not (OMAPS group). The women were treated at the previously-mentioned hospitals on an inpatient or outpatient basis.Apart from the clinical Sydney criteria, a wide open list of obstetric morbidities potentially related to placental dysfunction such as late intrauterine growth restriction (>34 weeks of pregnancy), abruptio placentae at term, or placental haematoma, and laboratory data such as low-medium titres of aCL and/or antiβ2-GPI, or non-persistently positive aPL, are suggested for inclusion in the OMAPS group. All recruited cases and participating hospitals received a code number to ensure privacy and personal data protection. One physician from each of the eleven hospitals formed the interlocutor group. This centralised Registry was approved by the Review Board and Ethics Committee of the Vall d tm)Hebron University Hospital and by the University Departments of Medicine and Obstetrics of the Universitat Autònoma of Barcelona. The standardised forms once completed could be returned by post or e-mail.Clinical inclusion criteriaWomen with pregnancy morbidity related to aPL: (a) OAPS group: women fulfilling Sydney classification criteria,<a class="elsevierStyleCrossRef" href="#bib0140">1</a> and (b) OMAPS group: women suffering obstetric complications related to aPL but not fulfilling Sydney classification criteria: prematurity (<37 weeks of pregnancy) with no other apparent cause but placental, 2 consecutive miscarriages <10 weeks of pregnancy, late onset preeclampsia (after 34 weeks), late intrauterine growth restriction (after 34w), placental haematoma (subchorionic bleeding or the accumulation of blood within the folds of the chorion or between the uterus and the placenta) • abruptio placentae before or after 34 weeks. No history of previous documented thrombotic events • at least 1 clinical episode of venous, arterial or small vessel thrombosis, in any tissue or organ except the placenta, with thrombosis being confirmed by objective validated criteria-, and no evidence of any kind of treatment given previously that could suppose the existence of a thrombotic event, such as full-dose anticoagulants in at least the previous 5 years, before entering this study, had to be ensured in order to be included. Each patient may have had one or more pregnancy episodes. Similarly, all previous obstetric events suffered by each woman are considered.Laboratory inclusion criteriaStandard laboratory criteria according to Sydney recommendations • lupus anticoagulant; anticardiolipin antibodies (aCL), IgG and IgM isotypes and anti-β2glycoprotein-I antibodies (anti-β2GPI) IgG and IgM isotypes-tested positive with high titres (according to the interval values of the respective laboratories) at least twice were obligatorily to be included in the OAPS group and classified as follows: Category I (more than one aPL positivity); Category II (only one aPL positivity): IIa: LA+; IIb: aCL IgG and/or IgM+, and IIc: anti-β2GPI IgG and/or IgM+. On the other hand, women with aCL, IgG and IgM isotypes and anti-β2GPI IgG and IgM isotypes, who tested positive with high titres only once or at least twice but in low-medium titres, and those with LA present but not persistently positive, were obligatorily to be included in the OMAPS group. In turn, we divided the OMAPS group in two subsets: (A) women who met Sydney laboratory criteria, but not clinical ones (n=24), and (B) women who did not fulfil Sydney laboratory criteria, regardless of clinical criteria (n=67). Despite not meeting the Sydney laboratory criteria, all these 67 women belonging to the OMAPS subgroup B were sub-classified according to the Sydney laboratory categories (I, IIa, IIb, IIc) to allow us to make an accurate comparison analysis between OAPS and OMAPS groups.Clinical exclusion criteriaWomen with pregnancy losses explained by genetic, infectious, metabolic, anatomic or hormonal factors or maternal and paternal chromosomal causes were also excluded. Karyotype data from less than 50% of miscarriages, foetal loss and stillbirth was available. The authors are mindful of the significance of this lack of information.Laboratory exclusion criteriaWomen with non-standard aPL, i.e. aPT/aFS antibodies or IgA isotype, were not included.AssaysAntiphospholipid antibodiesScreening assays were used to detect LA according to the Sydney recommendations of the ISTH Subcommittee. Plasma aCL-IgG/IgM and anti-β2GPI IgG/IgM antibody titres were usually determined by commercial ELISA methods. In several cases, an in-house ELISA was used. The results of aCL were expressed as immunoglobulin G phospholipid (GPL) or immunoglobulin M phospholipid (MPL) using international reference material. The results of anti-β2GPI IgG/IgM assays were calculated in arbitrary units using a standard curve obtained from a pool of positive calibrated accurately samples.In accordance with Sapporo recommendations, all plasmas were analysed for the four-solid-phase aPL antibody by methods based on calibration curves established using the Sapporo standards.<a class="elsevierStyleCrossRef" href="#bib0140">1</a> The cut-off values used for medium-high titres of aCL antibodies were 40 GPL and/or MPL and low titres between 15•39 and/or MPL, before February 2006. Beginning in February 2006, in accordance with the Sydney classification criteria, the cut-off values used for medium/high titres for both aCL and anti-β2GPI antibodies were calculated using either the Sapporo standards or the 99th percentile obtained by testing age-matched healthy women. aPL positivity had to have been present at least twice, with a minimum interval of 12 weeks. According to the advertisement of the experts,<a class="elsevierStyleCrossRef" href="#bib0140">1</a> in where investigators are strongly advised to classify APS patients in studies into different categories (I, more than one laboratory criteria present (any combination); IIa, LA present alone; IIb, aCL antibody present alone; IIc, anti-β2 glycoprotein-I antibody present alone), the authors have decided to use this classification criteria.Statistical analysisValues are expressed as mean, standard deviation, median, 25th and 75th percentiles (Q1 and Q3, respectively), sum and extreme values (minimum and maximum) for continuous variables and number and percentages for qualitative variables. Student's t-test was used to compare values following normal distribution, while Mann•Whitney•Wilcoxon's test or Kruskal•Wallis test was used for data not following a normal distribution. Chi-square test and Fisher's exact test were used to compare categorical variables. Univariate logistic regression analysis was used to estimate the risks of analytical parameters in the presence of the studied morbidities. The statistical software SAS (ver. 9.3) was used to analyse the datasets (Bioclever Clinical Trials, Barcelona, Spain).ResultsPatient baseline clinical characteristicsBriefly, 338 women who had suffered 1253 obstetric episodes (pregnancies) were included; 915 episodes were historical. 247 of 338 women (73%) fulfilled the Sydney classification criteria (OAPS group) and 91 of 338 (26.9%) women had incomplete clinical and/or laboratory criteria (OMAPS group). Apart from age (p<0.004), no differences were observed between groups regarding other epidemiological parameters. Data summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Laboratory characteristics and obstetrics-related morbiditiesLaboratory categoriesOverall • assuming that the majority of OMAPS women (subset B: 73.6%) did not accomplish the laboratory Sydney criteria (the other 26.3%, OMAPS Subset A, fulfilled laboratory, but not clinical criteria)-, statistical differences were observed when OMAPS and OAPS were compared in both categories I and II, with category I being significantly more prevalent in the OAPS group (p<0.0001), and category II in OMAPS (p=0.0001). In more detail and with each isotype being considered an independent parameter, double (p=0.0011) and triple (p=0.0353) positivities, as well as category IIa, were more frequent in OAPS (p=0.0310). Categories IIb and IIc were more frequent in OMAPS than in OAPS (p=0.0025 and p=0.0052, respectively); moreover, statistical differences for isolated IgG and IgM for category IIb, and isolated IgG for IIc were also observed. Data depicted in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>As expected, no statistical differences were found when OMAPS subset A (fulfilling laboratory Sydney criteria, but not clinical) and OAPS were compared; however, significant results were obtained for all categories and for the distribution of different isotype combinations in subsets IIb and IIc when OAPS was compared specifically with OMAPS subset B (not fulfilling Sidney laboratory criteria). (<a class="elsevierStyleCrossRef" href="#sec0135">Data depicted in Table 2.1 and Table 2.2, respectively, in the attached document 1 online version</a>.).Complement pathway resultsPlasma complement levels were analysed in 50/91 women (54.94%) in the OMAPS group and in 201/247 (81.37%) in OAPS; significant differences were observed only when low C3 and C4 levels taken together in each group were compared (p=0.0282).Associated inherited clot pathway disordersData on inherited thrombophilia were available in 208 women [208/338 (61.53%)]: 147 in OAPS and 61 in OMAPS. Although a higher percentage of inherited thrombophilia was found in OMAPS than in OAPS, no significant differences were observed: 40/147 (27.21%) vs. 20/61 (32.78%) (p=0.4190).Obstetric and foetal outcomesObstetric outcomesNo statistically-significant differences were observed in the majority of previous obstetric complications between groups, except for foetal loss which was more frequent in OAPS: OAPS 77/247 (31.2%) vs. OMAPS 14/91 (15.4%) (p=0.0037). (<a class="elsevierStyleCrossRef" href="#sec0135">Data depicted in Table A in the attached document 1 online version</a>.)Current obstetric complications appeared in 43/91 (47.25%) cases in OMAPS and 129/247 (52.2%) in OAPS (p=0.4811). The most commonly observed complication in both groups was prematurity (delivery before 37 weeks at least) and no significant differences in obstetric morbidity were observed between groups despite being the OAPS group older than OMAPS. The authors are concerned about the fact that the unique item that makes the difference between the two main groups is the laboratory criteria, but we decided to compare both groups, in order to analyse possible differences according to the obstetric complications. Comparing cases not fulfilling clinical Sydney criteria between the two whole groups was not possible due to obvious reasons (no patients in OAPS group). Data comparing current Sydney fulfilling obstetric complications between the whole two groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>All patients in OAPS group (100%) and the majority of patients (67.03%) in the OMAPS group fulfilled clinical Sydney criteria. Although, a not inconsiderable 33% of OMAPS patients did not: all patients in Subgroup A and only 6 patients (8.9%) in Subgroup B. The clinical characteristics of the two OMAPS subgroups are detailed in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Foetal outcomesFoetal outcomes in OMAPS compared with OAPS are detailed in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>. In short, live births were achieved in 71/91 (78.02%) cases in OMAPS vs. 193/247 (78.13%) in OAPS (p=0.9687). No differences either in the percentage of unsuccessful cases or in the percentage of women treated were observed when the OMAPS and OAPS were compared.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Maternal outcomesUnfortunately, we had data on puerperal thrombosis in only 49 women in the OMAPS group and 164 in the OAPS group. Gestational venous thromboses were reported in two cases in the OAPS group. No arterial thrombosis was observed. In the puerperal period, thrombosis appeared in 10.20% of cases (5/49, 1 arterial, 4 venous) in OMAPS vs. 8.53% of cases (14/164, 3 arterial, 11 venous) in OAPS. The arterial area involved was the middle cerebral artery in three cases and unknown in the fourth. Women suffering arterial thrombosis were put under Acenocumarol regime; deep venous thromboses in the OMAPS group involved femoral (2 cases) and ilio-femoral (2 cases) areas. Only two of these 5 women suffering puerperal thrombosis in the OMAPS group had received treatment during pregnancy: one with heparin alone and the other with LDA plus heparin. Interestingly, both episodes coincided with the abrupt cessation of heparin and aspirin before completing 6 weeks after delivery. By contrast, all women in the OAPS group who developed arterial (3 cases) and venous thrombosis (11 cases) during the puerperal period had received LDA and heparin; as we have pointed previously women suffering arterial thrombosis received warfarin regimen, and women suffering venous thrombosis were put under anticoagulant doses of LMHW.Clinical follow-up data were only available from 225 women in OAPS, and 82 in OMAPS.Interestingly, after 6 month monitoring developments, 7 women in OAPS group met the standard criteria for LUPUS; six of them suffered puerperal thrombosis (2 arterial 4 venous); 3 women developed other autoimmune diseases.Data of maternal outcomes according to thrombosis and clinical follow-up are depicted in <a class="elsevierStyleCrossRef" href="#sec0135">Table B in the attached document 1 online version</a>.Analysis of treatmentThe major results of therapeutic schedules of the two groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>. Briefly, 69/91 (75.82%) in the OMAPS vs. 213/247 (86.20%) in the OAPS were started on treatment (p=0.0224). Interestingly, only 73.91% received the LDA plus heparin combination in the OMAPS, compared to OAPS, 83.09% (p=0.006). Only 74/213 (34.7%) vs. 22/69 (31.88%) were put on LDA pre-conceptionally in the OAPS and OMAPS groups, respectively. Daily LDA doses used were 100mg in all treated cases in both groups, and LMWH was used in different schedules. Prophylactic doses of LMWH were administered as follows: low-dose 15/51 (29.41%) and medium-dose in 36/51 (70%). As in OAPS, the majority of OMAPS cases were treated with LMWH, being enoxaparin the most selected drug. Anti-factor Xa activity was not usually monitored. No drug-related adverse effects, significant heparin-induced thrombocytopenia or thrombocytopenia-thrombosis were reported.<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>DiscussionThe overall study population yielded a non-negligible obstetric morbidity rate of 50.88%; specifically, 52.2% in OAPS and 47.3% in OMAPS. According to the different published series, the percentages of early recurrent miscarriage, foetal loss/stillbirth, pre-eclampsia, foetal growth restriction or prematurity in women with OAPS and with incomplete forms (OMAPS) showed a wide variation.<a class="elsevierStyleCrossRefs" href="#bib0175">8,16,17</a> In the Registry, when referring to previous pregnancies, miscarriage before 10 weeks proved to be the most prevalent obstetric complication in both groups, followed by foetal loss which was significantly more prevalent in OAPS; in most of those OAPS cases, these fatal complications permitted physicians to correctly diagnose the syndrome and establish the best treatment for further pregnancies. When data related to the current pregnancy were analysed, some percentages changed markedly; however, despite the differences according Sydney clinical criteria observed between groups, statistical significance was not reached. Although the foetal loss rate remained still higher in OAPS, stillbirth showed an inverse correlation and was more prevalent in OMAPS, probably due to successful management of cases with poor previous obstetric outcomes that permitted and early diagnose of the OAPS. Current miscarriage • and thus, disclosing recurrent miscarriage cases • complicated 20.93% of OMAPS pregnancies and 16.27% of OAPS. Prematurity (defined as delivery at least before 37 weeks of pregnancy) with no other apparent cause but placental failure was the most prevalent obstetric outcome in both groups, followed by foetal loss in OAPS and severe early-onset PE in OMAPS. Since that other causes of prematurity were ruled out, a potential relationship between aPL and prematurity should be considered. The majority of women with an OMAPS did not fulfil the APS laboratory criteria. Only 26.37% of OMAPS women repeatedly tested positive for one or more aPL, but did not met the clinical criteria. In this subgroup, the laboratory results and distribution of the different laboratory categories did not differ significantly from those of the OAPS group, as expected. This observation raises the question of whether aPL should be sought in women with hidden OAPS in which a timely correct treatment would avoid worse clinical outcomes. Forastiero<a class="elsevierStyleCrossRef" href="#bib0240">21</a> reported a relationship between obstetric complications and diverse aPL types and titres, some of which are not included as markers for OAPS, and suggested that other forms of aPL, other than the classical, should be considered in the laboratory criteria, and other authors concur.<a class="elsevierStyleCrossRefs" href="#bib0170">7•9</a> Chighizola et al.<a class="elsevierStyleCrossRef" href="#bib0245">22</a> in a systematic review, reported a positive association between aPL and diverse obstetric complications, some of which are not included in the Sydney obstetric morbidity criteria. Laboratory results in the OAPS group were similar to the data published elsewhere<a class="elsevierStyleCrossRef" href="#bib0175">8</a> for all aPL categories and isotypes. According to the Registry laboratory results, significant differences among the different laboratory categories were observed between OAPS and OMAPS groups. Although these women did not fulfil the laboratory Sydney requirements, we decided to classify them as “incomplete” laboratory results as in OAPS. Thus, our results demonstrate that all aPL categories and isotypes should be considered together to yield more information leading to optimum management of these women.In the Registry, no women suffered demonstrable thrombosis during pregnancy, and only 14 and 5 women suffered puerperal thrombosis in the OAPS and OMAPS groups, respectively. These results reinforce the hypothesis that certain cases will have only obstetric complications with few or no thrombotic events, other than placental, episodes over time.<a class="elsevierStyleCrossRefs" href="#bib0145">2,23,24</a> Moreover, it is worth mentioning that inherited thrombophilia is not considered to be a risk factor or have an association with OAPS.<a class="elsevierStyleCrossRef" href="#bib0260">25</a>A considerable percentage of women in both group were put under treatment, while significantly higher in OAPS group. The combination of LDA and LMWH was widely used in both groups, and good maternal and foetal outcomes in both groups were observed when treated. Although, almost 17% of OAPS women did not receive the recommended schedule. Moreover, in light of the recent data on aPL-related obstetric pathology, we believe treatment should be started as early as possible.<a class="elsevierStyleCrossRefs" href="#bib0265">26,27</a> Interestingly LDA before pregnancy and LDA plus LMWH during pregnancy was administered only in less than one-third of cases. Based on the morbidity rates, it is clear that our therapeutic approaches need to be improved. We highlight that the live birth rate was quite acceptable in both groups, but higher in the OAPS treated group than in OMAPS treated group. Thus, we should conclude that improving therapeutic approach would bring with better outcomes in both groups.The Registry has some weak points. First of all, the inclusion of methods that merge retrospective and prospective cases could raise concerns for data analysis and therefore, to avoid them, only the data of the latest pregnancy of each woman were fully analysed. When a woman already included in the registry added another current pregnancy, database automatically send the last episode as a previous one. Secondly, aPL test results were difficult to interpret in certain cases since different commercial and home-made methods were used. Conversely, the inclusion of laboratory data from different centres could also prevent a possible bias attributable to one or few laboratories.No all the cases were sent or recruited with full information about embryo-foetal or parental karyotype in RM of foetal loss, clinical or laboratory items such congenital thrombophilia or puerperal follow-up. Moreover, the retrospective data, are more used to lose information, mostly in some cases with no current episode, but previous only.Regarding the strong points, the number of obstetric APS cases studied (OAPS) and “incomplete APS” women (OMAPS) with more than 1000 historical episodes represents one of the largest series in this field. Finally, the inclusion of patients from multiple centres enriches the Registry and minimises any bias that may arise when results are provided by a single centre.ConclusionNo differences in clinical complications and maternal and foetal outcomes were observed when the two groups of this Registry were compared. Recurrent first trimester miscarriage followed by foetal loss plus stillbirth and early onset preeclampsia were the most common obstetric morbidities in this cohort. Interestingly, inter-group differences in laboratory categories were observed, with category II being more frequent in the OMAPS group and category I in the OAPS group. Maternal and foetal outcomes were good when the currently recommended treatment was given. Indeed, the lack of differences between complete and incomplete forms reinforces the attitude of some experts that this last group of women could have the same risk as those suffering OAPS. Thus, they deserve a similar management to OAPS patients.Nevertheless, further research into the OMAPS forms is required for better understanding of the main pathophysiological pathways involved and possible new laboratory markers. Considering that the reported prevalence of aPL is relatively high and heterogeneous in the general population, it is possible that aPL variations through pregnancy and that preliminary data revealing the value of other aPL levels, types and isotypes not yet included in the Sydney criteria are increasing; we agree with several authors who claimed that the current classification criteria are too restrictive for the Obstetric Antiphospholipid Syndrome and therefore many women are left undiagnosed and untreated.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1096290" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1038046" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1096289" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento Y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material Y mèc)todos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1038045" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background and objectives" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study design" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Clinical inclusion criteria" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Laboratory inclusion criteria" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Clinical exclusion criteria" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Laboratory exclusion criteria" ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Assays" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Antiphospholipid antibodies" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0060" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Patient baseline clinical characteristics" ] 1 => array:3 [ "identificador" => "sec0070" "titulo" => "Laboratory characteristics and obstetrics-related morbidities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Laboratory categories" ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Complement pathway results" ] 2 => array:2 [ "identificador" => "sec0085" "titulo" => "Associated inherited clot pathway disorders" ] ] ] 2 => array:3 [ "identificador" => "sec0090" "titulo" => "Obstetric and foetal outcomes" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0095" "titulo" => "Obstetric outcomes" ] 1 => array:2 [ "identificador" => "sec0100" "titulo" => "Foetal outcomes" ] 2 => array:2 [ "identificador" => "sec0105" "titulo" => "Maternal outcomes" ] ] ] 3 => array:2 [ "identificador" => "sec0110" "titulo" => "Analysis of treatment" ] ] ] 7 => array:2 [ "identificador" => "sec0115" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0120" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0125" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-04-30" "fechaAceptado" => "2017-11-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1038046" "palabras" => array:4 [ 0 => "Antiphospholipid antibody" 1 => "Antiphospholipid syndrome" 2 => "Obstetric morbidity, Incomplete obstetric antiphospholipid syndrome" 3 => "Registry" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1038045" "palabras" => array:5 [ 0 => "Anticuerpos antifosfolípido" 1 => "Síndrome antifosfolípido" 2 => "Morbilidad obstèc)trica" 3 => "Síndrome antifosfolípido obstèc)trico incompleto" 4 => "Registro" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectivesTo compare clinical, laboratory, treatment and live birth rate data between women with aPL-related obstetric complications (OMAPS) not fulfilling the Sydney criteria and women fulfilling them (OAPS). Materials and methodsRetrospective and prospective multicentre study. Data comparison between groups from The European Registry on Antiphospholipid Syndrome included within the framework of the European Forum on Antiphospholipid Antibody projects. Results338 women were analysed: 247 fulfilled the Sydney criteria (OAPS group) and 91 did not (OMAPS group). In the OMAPS group, 24/91 (26.37%) fulfilled laboratory Sydney criteria (subgroup A) and 67/91 (74.63%) had a low titre and/or non-persistent aPL-positivity (subgroup B). Overall, aPL laboratory categories in OAPS vs. OMAPS showed significant differences: 34% vs. 11% (p<0.0001) for category I, 66% vs. 89% (p<0.0001) for category II. No differences were observed when current obstetric complications were compared (p=0.481). 86.20% of OAPS women were treated vs. 75.82% of OMAPS (p=0.0224), particularly regarding the LDA+LMWH schedule (p=0.006). No differences between groups were observed in live births, gestational, puerperal arterial and/or venous thrombosis. ConclusionsSignificant differences were found among aPL categories between groups. Treatment rates were higher in OAPS. Both OAPS and OMAPS groups had similarly good foetal-maternal outcomes when treated. The proposal to modify OAPS classification criteria, mostly laboratory requirements, is reinforced by these results." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Fundamento Y objetivosComparar características clínicas, analíticas, tratamiento y tasa de hijos vivos entre gestantes con Síndrome Antifosfolípido Obstèc)trico (SAFO) y gestantes con morbilidad obstèc)trica relacionada con el síndrome que no cumplen los criterios de clasificación actuales. Material Y mèc)todosEstudio observacional retrospectivo y prospectivo multicèc)ntrico: datos de once hospitales terciarios europeos recogidos en el European Registry on Antiphospholipid Syndrome. ResultadosSe analizaron 338 mujeres: 247 cumplían criterios de Sydney para SAFO (grupo OAPS), y 91 no (grupo OMAPS). En el grupo OMAPS, 24/91(26.37%) cumplían criterios analíticos, pero no clínicos para SAFO (subgrupo A) y 67/91(74.63%) presentaban títulos medio-bajos o títulos positivos no persistentes de anticuerpos antifosfolípido, con o sin cumplir criterios clínicos (subgrupo B). Se observaron diferencias significativas entre los 2 grupos en cuanto a las categorías analíticas: 34% vs. 11% (p<0.0001) para la categoría I y 66% vs. 89% (p<0.0001) para la categoría II, OAPS vs OMAPS, respectivamente. No se observaron diferencias significativas en cuanto a las complicaciones obstèc)tricas (p=0.481). El 86.20% del grupo OAPS recibió tratamiento vs.el 75.82% del grupo OMAPS (p=0.0224). No se observaron diferencias en la tasa de hijos vivos, ni en la tasa de trombosis arterial y/o venosa gestacional y/o puerperal. ConclusionesAmbos grupos fueron muy homogèc)neos, excepto en cuanto a la distribución de las categorías analíticas y en la tasa de tratamiento. Ambos grupos mostraron buenos resultados al ser tratados. Los resultados respaldan la opinión de muchos expertos de tener que revisar los criterios de clasificación actuales del Síndrome Antifosfolípido Obstèc)trico." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento Y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material Y mèc)todos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0135" ] ] ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2788 "Ancho" => 2018 "Tamanyo" => 519630 ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics of patients in the two OMAPS subgroups." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Chi-square test and Mann•Whitney•Wilcoxon U test; BMI: body mass index; OAPS: obstetric antiphospholipid syndrome; OMAPS: obstetric morbidity related to antiphospholipid antibodies; SLE: systemic lupus erythematosus." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Demographic characteristic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS (N=247) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS (N=91) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (mean±SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.18 (6.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.71 (7.47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0040 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Ethnicity (n)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">African \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="6" align="char" valign="top">0.3005</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">American/Caribbean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Latino \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (3.23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (6.59%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.21%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">220 (89.06%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (83.51%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jewish/Arab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (4.85%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (7.69%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoker (n) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (22%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (21.97%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9958 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI mean±SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.0 (3.35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.4 (4.44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0533 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">S.L.E. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (11%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0637 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other autoimmune diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (10.93%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (12.08%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7652 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inherited thrombophilia(n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39/145 (26.89%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20/58 (34.48%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2822 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1874017.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic characteristics and main general data of two groups." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Laboratory category \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS (N=247) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS (N=91) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84/247 (34%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10/91 (11%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Double + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58/247 (23.48%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/91 (7.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0011 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA+aCL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25/247 (10.12%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/91 (2.19%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0172 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA+antiβ2GPI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/247 (2.83%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0/91 (0.00%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1962 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">aCL+antiβ2GPI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26/247 (10.52%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/91 (5.49%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1551 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triple+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26/247 (10.52%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3/91 (3.29%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0353 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">163/247 (65.99%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81/91 (89.01%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIa (LA+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42/247 (17%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/91 (7.69%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0310 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIb (aCL+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66/247 (26.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40/91 (43.95%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0025 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgG+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31/247 (12.55%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21/91 (23.07%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0174 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgM+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12/247 (4.85%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15/91 (16.48%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgG+ & IgM+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23/247 (9.31%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4/91 (4.39%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1392 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIc (antiβ2GPI+) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55/247 (22.26%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34/91 (37.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0052 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgG+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16/247 (6.47%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17/91 (18.68%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgM+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15/247 (6.07%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9/91 (9.89%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2255 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgG+& IgM+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24/247 (9.71%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8/91 (8.79%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7966 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1874015.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Considering every isotype as an independent laboratory parameter." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Chi-square test or Fisher's exact test." ] ] ] "descripcion" => array:1 [ "en" => "Comparative laboratory results between OAPS and OMAPS groups.<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "FGR: foetal growth restriction (retardation)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obstetrical complications \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS (n=247) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS(n=91) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118/247 (47.77%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (52.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4811 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">129 (52.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (47.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recurrent miscarriage (current episode) (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21/129 (16.27%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9/43 (20.93%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7243 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Foetal loss (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23/129 (17.82%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/43 (11.62%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3401 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stillbirth (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11/129 (8.52%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/43 (16.27%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1588 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Foetal loss & stillbirth(n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34/129 (26.35%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12/43 (27.90%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8423 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prematurity (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61/129 (47.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20/43 (34.88%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8590 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early-onset PE+prematurity (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17/129 (13.17%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10/43 (23.25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1157 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HELLP+prematurity (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/129 (5.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/43 (11.62%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1775 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early FGR+prematurity (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18/129 (13.95%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/43 (16.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7079 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early-onset PE/HELLP+FGR+prematurity (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15/129 (11.62%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/43 (16.27%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5310 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abruptio placentae (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5/129 (3.87%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/43 (4.65%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Late-Onset PE (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16/129 (12.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7/43 (16.27%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5178 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Placenta haematoma (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/129 (0.77%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/43 (4.65%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1546 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Late IUGR (n/N) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2/129 (1.55%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1/43 (2.32%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.0000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1874014.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Chi-square test or Fisher's exact test." ] ] ] "descripcion" => array:1 [ "en" => "Current pregnancy obstetrical complications in OAPS and OMAPS groups." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Chi-square test." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Live births \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS (n=247) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS (n=91) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes (n/N) Treatment No treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">193/247 (78.13%) 175/193 (90.67%) 18/193 (9.32%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71/91 (78.02%) 58/71 (81.69%) 13/71 (18.30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.9687 0.0444 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No (n/N) Treatment No treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55/247 (22.26%) 38/55 (69%) 17/55 (30.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20/91 (21.97%) 11/20 (55%) 9/20 (45%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.00 0.2568 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1874016.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Live births and treatment in OAPS and OMAPS group." ] ] 5 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Chi-square test or Fisher's exact test." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS (n=247) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS(n=91) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34/247 (13.76%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22/91 (24.17%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="left" valign="top">0.0224</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">213/247 (86.20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69/91 (75.82%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDA previous pregnancy (LDApp) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74/247 (29.95%) 74/213 (34.74%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22/91 (24.17%) 22/69 (31.88%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.2956 0.6633 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDA during pregnancy (LDAdp) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">207/247 (83.80%) 207/213 (97.18%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68/91 (74.72%) 68/69 (98.55%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0572 1.0000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LMWH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">182/247 (73.68%) 182/213 (85.44%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51/91 (56.04) 51/69 (75.36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0019 0.0280 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDA+LMWH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">177/247 (71.65%) 177/213 (83.09%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51/91 (56.04%) 51/69 (73.91%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.0066 0.0919 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Only LDAdp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22/247 (8.90%) 22/213 (10.32%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12/91 (13.18%) 12/69 (17.39%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.2459 0.1174 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LMWH only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/247 (2.02%) 5/213 (2.34%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.3293 0.3391 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDApp+LDAdp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/247 (3.23%) 8/213 (3.75%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/91 (5.49%) 5/69 (7.24%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.3472 0.3177 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDAdp+LMWH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">111/247 (44.93%) 111/213 (52.11%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34/91 (37.36%) 34/69 (49.27%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.2119 0.6819 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDApp+LDAdp+LMWH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66/247 (26.72%) 66/213 (30.98%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17/91 (18.68%) 17/69 (24.63%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1277 0.3146 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/247 (3.23%) 8/213 (3.75%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1143 0.2060 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1874018.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Treatment comparison between OAPS and OMAPS groups." ] ] 6 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 78114 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. 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Original article

Comparative study between obstetric antiphospholipid syndrome and obstetric morbidity related with antiphospholipid antibodies

Estudio comparativo entre síndrome antifisfolipídico obstèc)trico y morbilidad obstèc)trica relacionada con anticuerpos antifosfolípido

Jaume Alijotas-Reiga,

Corresponding author

jalijotas@vhebron.net
16297jar@comb.cat

Corresponding author.

, Enrique Esteve-Valverdeb, Raquel Ferrer-Oliverasc,

Corresponding author

raquelfo22@hotmail.com

Corresponding author.

, Elisa LLurbad, Amelia Ruffattie, Angela Tincanif, Elmina Lefkoug, Mª Tiziana Berteroh, Gerard Espinosai, Sara de Carolisj, Patrizia Rovere-Querinik, Krista Lundelinl, Elisa Picardom, Arsene Mekiniann, for the EUROAPS Study Group

a Systemic Autoimmune Disease Unit, Department of Internal Medicine, Vall d tm)Hebron University Hospital, Department of Medicine, Universitat Autonoma, Barcelona, Spain

b Internal Medicine Department, Althaia Healthcare Network of Manresa, Rheumatology Unit, Barcelona, Spain

c Obstetrics and Gynaecology Department, High Risk Unit, Vall d tm)Hebron University Hospital, Universitat Autonoma, Barcelona, Spain

d Obstetrics and Gynaecology Department, High Risk Unit, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

e Rheumatology Unit, Department of Clinical and Experimental Medicine Azienda Ospedaliera, University of Padua, Padua, Italy

f Rheumatology and Clinical Immunology Unit, Ospedale Civile, Brescia, Italy

g Haematology Unit, Hippokration Hospital of Thessaloniki, Greece

h Department of Clinical Immunology, A.O. Mauriziano-Umberto I, Turin, Italy

i Systemic Autoimmune Diseases Service, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain

j Department of Gynaecology, Gemmeli Hospital, Catholic University, Roma, Italy

k Scuola di Specializzazione in Allergologia e Immunolofia Clinica, U.O. Medicina ad indrizzo Immunlogico Clinico-Ospedale San Raffaele, Milano, Lab, Autoimminità e inflammazione vascolare • San Raffaele DIBIT, Milano, Italy

l Internal Medicine Department, Hospital Universitario La Paz, Universidad Autònoma, Madrid, Spain

m Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy

n AP-HP, Hôpital Saint-Antoine, service de mèc)decine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universitèc)s, UPMC Univ Paris 06, F-75012, Paris, France

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        "titulo" => "Estudio comparativo entre s&#237;ndrome antifisfolip&#237;dico obst&#232;c&#41;trico y morbilidad obst&#232;c&#41;trica relacionada con anticuerpos antifosfol&#237;pido"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of patients in the two OMAPS subgroups&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background and objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">The antiphospholipid syndrome &#40;APS&#41; is an autoimmune systemic disorder characterised by an increased risk of vascular thrombosis and&#47;or pregnancy morbidity&#44; both associated with persistently &#8226; positive antiphospholipid&#47;anticofactor antibody &#40;aPL&#41; tests according to the currently accepted Sydney criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> Thus&#44; for APS diagnosis&#44; at least one clinical criterion and one laboratory criterion are needed&#46; APS is believed to be related to activation of the clot cascade with further thrombosis&#46; Cases with poor obstetric outcomes&#44; mainly recurrent first trimester miscarriage&#44; foetal losses&#44; stillbirth&#44; early and severe preeclampsia leading to a preterm birth&#44; but without a history of thrombosis&#44; are known to have obstetric antiphospholipid syndrome &#40;OAPS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> Although no complete agreement exists&#44; there is evidence that laboratory markers&#44; immunopathological pathways&#44; treatment response&#44; maternal complications and long-term follow-up may differ from those observed in APS outside the context of pregnancy&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Consensus on the classification criteria for APS&#47;OAPS permitted clinicians to standardise patient groups&#44; but also generated controversy&#46; In the last decade&#44; a wide array of &#8220;non-criteria&#8221; obstetric morbidities and diverse non-classical aPL&#44; low titres of accepted aPL&#44; or other isotypes such as IgA&#44; have been increasingly proposed&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">5&#44;6</span></a> Women with pregnancy complications highly suggestive of OAPS but with persistently low titres for aPL&#44; and those with accepted laboratory aPL criteria but not presenting full obstetric morbidity criteria &#8226; e&#46;g&#46; two recurrent miscarriages or placental vascular insufficiency over 34 weeks of gestation &#8226; are classified as incomplete OAPS&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#44;8</span></a> In addition&#44; there is increasing discussion as to whether clinical cases with persistently negative titres for classical or non-classical aPL should be known as seronegative APS&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">9&#44;10</span></a> Several published manuscripts stressed the contrariness of both incomplete and seronegative APS&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#44;11</span></a> Obviously&#44; this raised practical clinical concerns regarding the classification and management of these women&#46; Few studies have reported that women with persistent low-titre aPL positivity have obstetric outcomes comparable to the general population&#59; thus&#44; they may have good obstetric outcomes with or without treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">12&#44;13</span></a> By contrast&#44; a recent study showed that anticardiolipin antibody &#40;aCL&#41; and anti-&#946;2glycoprotein-I antibody &#40;anti-&#946;2GPI&#41; low-positivity titres accurately identify women with aPL-related pregnancy complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8&#44;14&#8226;16</span></a> Given these considerations&#44; some authors have claimed that the current diagnostic criteria are too restrictive and of limited use for clinical purposes&#44; and have suggested redefining OAPS<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8&#44;15&#44;17&#8226;19</span></a>&#59; Thus&#44; some women could be underdiagnosed &#8226; false-negative diagnosis &#8226; with further foetal maternal complications&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2014&#44; the 14th International Congress on Antiphospholipid Antibodies Task Force Report on Obstetric APS concluded there is a paucity of data on several OAPS-related concerns and that new information should be obtained&#44; mainly through randomised clinical trials and large series of patients recruited from multicentre registries&#46; Moreover&#44; they exposed the growing controversy on the clinical meaning of low titres of aPLs in pregnancy morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Thus&#44; and within the EUROAPS project framework&#44; we decided to refer to this incomplete OAPS group as Obstetric Morbidity related to the Antiphospholipid Antibodies &#8226; OMAPS group&#46; Herein&#44; we present the results of the OMAPS group in terms of obstetric morbidity&#44; foetal and maternal outcomes&#44; laboratory results&#44; treatment rates and live birth rates&#44; compared with those of OAPS to shed some light on this matter&#44; and provide further reasons for continuing to study this still debatable APS subset&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">Owing to the wide clinical spectrum of APS and strong evidence of the existence of different aPL-mediated pathogenic mechanisms between classical and obstetric forms of the syndrome&#44; it was considered useful to create a single&#44; homogeneous database in a multicentre European Registry where physicians could send&#44; consult or insert patient data to facilitate and further understanding of several existing gaps associated with aPL-related obstetric syndromes&#44; both in women fulfilling the Sydney criteria and those who did not&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">From June 2010&#44; the ad-hoc website and database have been accessible and ongoing&#46; Since then&#44; patient data have been included systematically&#44; both retrospectively and prospectively&#44; as stated previously &#91;<a id="intr0005" class="elsevierStyleInterRef" href="http://www.euroaps.org/">www&#46;euroaps&#46;org</a>&#93; and are now accessible at&#58; &#91;<a id="intr0010" class="elsevierStyleInterRef" href="https://euroaps.wordpress.com/">https&#58;&#47;&#47;euroaps&#46;wordpress&#46;com</a>&#93;&#46; All information regarding this project can also be found on the website&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design</span><p id="par0035" class="elsevierStylePara elsevierViewall">Eleven tertiary referral centres at universities in five European countries are participating in the Registry&#46; Staffs at all centres are experienced in the management of patients with APS&#47;OAPS&#46; To date&#44; the cohort has consisted of 338 cases&#59; 247 met the proposed Sydney classification criteria &#40;OAPS group&#41; and 91 did not &#40;OMAPS group&#41;&#46; The women were treated at the previously-mentioned hospitals on an inpatient or outpatient basis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Apart from the clinical Sydney criteria&#44; a wide open list of obstetric morbidities potentially related to placental dysfunction such as late intrauterine growth restriction &#40;&#62;34 weeks of pregnancy&#41;&#44; abruptio placentae at term&#44; or placental haematoma&#44; and laboratory data such as low-medium titres of aCL and&#47;or anti&#946;2-GPI&#44; or non-persistently positive aPL&#44; are suggested for inclusion in the OMAPS group&#46; All recruited cases and participating hospitals received a code number to ensure privacy and personal data protection&#46; One physician from each of the eleven hospitals formed the interlocutor group&#46; This centralised Registry was approved by the Review Board and Ethics Committee of the Vall d&#8232;tm&#41;Hebron University Hospital and by the University Departments of Medicine and Obstetrics of the Universitat Aut&#242;noma of Barcelona&#46; The standardised forms once completed could be returned by post or e-mail&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical inclusion criteria</span><p id="par0045" class="elsevierStylePara elsevierViewall">Women with pregnancy morbidity related to aPL&#58; &#40;a&#41; OAPS group&#58; women fulfilling Sydney classification criteria&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> and &#40;b&#41; OMAPS group&#58; women suffering obstetric complications related to aPL but not fulfilling Sydney classification criteria&#58; prematurity &#40;&#60;37 weeks of pregnancy&#41; with no other apparent cause but placental&#44; 2 consecutive miscarriages &#60;10 weeks of pregnancy&#44; late onset preeclampsia &#40;after 34 weeks&#41;&#44; late intrauterine growth restriction &#40;after 34w&#41;&#44; placental haematoma &#40;subchorionic bleeding or the accumulation of blood within the folds of the chorion or between the uterus and the placenta&#41; &#8226; abruptio placentae before or after 34 weeks&#46; No history of previous documented thrombotic events &#8226; at least 1 clinical episode of venous&#44; arterial or small vessel thrombosis&#44; in any tissue or organ except the placenta&#44; with thrombosis being confirmed by objective validated criteria-&#44; and no evidence of any kind of treatment given previously that could suppose the existence of a thrombotic event&#44; such as full-dose anticoagulants in at least the previous 5 years&#44; before entering this study&#44; had to be ensured in order to be included&#46; Each patient may have had one or more pregnancy episodes&#46; Similarly&#44; all previous obstetric events suffered by each woman are considered&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Laboratory inclusion criteria</span><p id="par0050" class="elsevierStylePara elsevierViewall">Standard laboratory criteria according to Sydney recommendations &#8226; lupus anticoagulant&#59; anticardiolipin antibodies &#40;aCL&#41;&#44; IgG and IgM isotypes and anti-&#946;2glycoprotein-I antibodies &#40;anti-&#946;2GPI&#41; IgG and IgM isotypes-tested positive with high titres &#40;according to the interval values of the respective laboratories&#41; at least twice were obligatorily to be included in the OAPS group and classified as follows&#58; Category I &#40;more than one aPL positivity&#41;&#59; Category II &#40;only one aPL positivity&#41;&#58; IIa&#58; LA&#43;&#59; IIb&#58; aCL IgG and&#47;or IgM&#43;&#44; and IIc&#58; anti-&#946;2GPI IgG and&#47;or IgM&#43;&#46; On the other hand&#44; women with aCL&#44; IgG and IgM isotypes and anti-&#946;2GPI IgG and IgM isotypes&#44; who tested positive with high titres only once or at least twice but in low-medium titres&#44; and those with LA present but not persistently positive&#44; were obligatorily to be included in the OMAPS group&#46; In turn&#44; we divided the OMAPS group in two subsets&#58; &#40;A&#41; women who met Sydney laboratory criteria&#44; but not clinical ones &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&#44; and &#40;B&#41; women who did not fulfil Sydney laboratory criteria&#44; regardless of clinical criteria &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41;&#46; Despite not meeting the Sydney laboratory criteria&#44; all these 67 women belonging to the OMAPS subgroup B were sub-classified according to the Sydney laboratory categories &#40;I&#44; IIa&#44; IIb&#44; IIc&#41; to allow us to make an accurate comparison analysis between OAPS and OMAPS groups&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Clinical exclusion criteria</span><p id="par0055" class="elsevierStylePara elsevierViewall">Women with pregnancy losses explained by genetic&#44; infectious&#44; metabolic&#44; anatomic or hormonal factors or maternal and paternal chromosomal causes were also excluded&#46; Karyotype data from less than 50&#37; of miscarriages&#44; foetal loss and stillbirth was available&#46; The authors are mindful of the significance of this lack of information&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Laboratory exclusion criteria</span><p id="par0060" class="elsevierStylePara elsevierViewall">Women with non-standard aPL&#44; i&#46;e&#46; aPT&#47;aFS antibodies or IgA isotype&#44; were not included&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Assays</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Antiphospholipid antibodies</span><p id="par0065" class="elsevierStylePara elsevierViewall">Screening assays were used to detect LA according to the Sydney recommendations of the ISTH Subcommittee&#46; Plasma aCL-IgG&#47;IgM and anti-&#946;2GPI IgG&#47;IgM antibody titres were usually determined by commercial ELISA methods&#46; In several cases&#44; an in-house ELISA was used&#46; The results of aCL were expressed as immunoglobulin G phospholipid &#40;GPL&#41; or immunoglobulin M phospholipid &#40;MPL&#41; using international reference material&#46; The results of anti-&#946;2GPI IgG&#47;IgM assays were calculated in arbitrary units using a standard curve obtained from a pool of positive calibrated accurately samples&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In accordance with Sapporo recommendations&#44; all plasmas were analysed for the four-solid-phase aPL antibody by methods based on calibration curves established using the Sapporo standards&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> The cut-off values used for medium-high titres of aCL antibodies were 40 GPL and&#47;or MPL and low titres between 15&#8226;39 and&#47;or MPL&#44; before February 2006&#46; Beginning in February 2006&#44; in accordance with the Sydney classification criteria&#44; the cut-off values used for medium&#47;high titres for both aCL and anti-&#946;2GPI antibodies were calculated using either the Sapporo standards or the 99th percentile obtained by testing age-matched healthy women&#46; aPL positivity had to have been present at least twice&#44; with a minimum interval of 12 weeks&#46; According to the advertisement of the experts&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> in where investigators are strongly advised to classify APS patients in studies into different categories &#40;I&#44; more than one laboratory criteria present &#40;any combination&#41;&#59; IIa&#44; LA present alone&#59; IIb&#44; aCL antibody present alone&#59; IIc&#44; anti-&#946;<span class="elsevierStyleInf">2</span> glycoprotein-I antibody present alone&#41;&#44; the authors have decided to use this classification criteria&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Values are expressed as mean&#44; standard deviation&#44; median&#44; 25th and 75th percentiles &#40;Q1 and Q3&#44; respectively&#41;&#44; sum and extreme values &#40;minimum and maximum&#41; for continuous variables and number and percentages for qualitative variables&#46; Student&#39;s <span class="elsevierStyleItalic">t</span>-test was used to compare values following normal distribution&#44; while Mann&#8226;Whitney&#8226;Wilcoxon&#39;s test or Kruskal&#8226;Wallis test was used for data not following a normal distribution&#46; Chi-square test and Fisher&#39;s exact test were used to compare categorical variables&#46; Univariate logistic regression analysis was used to estimate the risks of analytical parameters in the presence of the studied morbidities&#46; The statistical software SAS &#40;ver&#46; 9&#46;3&#41; was used to analyse the datasets &#40;Bioclever Clinical Trials&#44; Barcelona&#44; Spain&#41;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Results</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Patient baseline clinical characteristics</span><p id="par0080" class="elsevierStylePara elsevierViewall">Briefly&#44; 338 women who had suffered 1253 obstetric episodes &#40;pregnancies&#41; were included&#59; 915 episodes were historical&#46; 247 of 338 women &#40;73&#37;&#41; fulfilled the Sydney classification criteria &#40;OAPS group&#41; and 91 of 338 &#40;26&#46;9&#37;&#41; women had incomplete clinical and&#47;or laboratory criteria &#40;OMAPS group&#41;&#46; Apart from age &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#44; no differences were observed between groups regarding other epidemiological parameters&#46; Data summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Laboratory characteristics and obstetrics-related morbidities</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Laboratory categories</span><p id="par0085" class="elsevierStylePara elsevierViewall">Overall &#8226; assuming that the majority of OMAPS women &#40;subset B&#58; 73&#46;6&#37;&#41; did not accomplish the laboratory Sydney criteria &#40;the other 26&#46;3&#37;&#44; OMAPS Subset A&#44; fulfilled laboratory&#44; but not clinical criteria&#41;-&#44; statistical differences were observed when OMAPS and OAPS were compared in both categories I and II&#44; with category I being significantly more prevalent in the OAPS group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; and category II in OMAPS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; In more detail and with each isotype being considered an independent parameter&#44; double &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0011&#41; and triple &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0353&#41; positivities&#44; as well as category IIa&#44; were more frequent in OAPS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0310&#41;&#46; Categories IIb and IIc were more frequent in OMAPS than in OAPS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0025 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0052&#44; respectively&#41;&#59; moreover&#44; statistical differences for isolated IgG and IgM for category IIb&#44; and isolated IgG for IIc were also observed&#46; Data depicted in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">As expected&#44; no statistical differences were found when OMAPS subset A &#40;fulfilling laboratory Sydney criteria&#44; but not clinical&#41; and OAPS were compared&#59; however&#44; significant results were obtained for all categories and for the distribution of different isotype combinations in subsets IIb and IIc when OAPS was compared specifically with OMAPS subset B &#40;not fulfilling Sidney laboratory criteria&#41;&#46; &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Data depicted in Table 2&#46;1 and Table 2&#46;2&#44; respectively&#44; in the <span class="elsevierStyleItalic">attached document 1 online version</span></a>&#46;&#41;&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Complement pathway results</span><p id="par0095" class="elsevierStylePara elsevierViewall">Plasma complement levels were analysed in 50&#47;91 women &#40;54&#46;94&#37;&#41; in the OMAPS group and in 201&#47;247 &#40;81&#46;37&#37;&#41; in OAPS&#59; significant differences were observed only when low C3 and C4 levels taken together in each group were compared &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0282&#41;&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Associated inherited clot pathway disorders</span><p id="par0100" class="elsevierStylePara elsevierViewall">Data on inherited thrombophilia were available in 208 women &#91;208&#47;338 &#40;61&#46;53&#37;&#41;&#93;&#58; 147 in OAPS and 61 in OMAPS&#46; Although a higher percentage of inherited thrombophilia was found in OMAPS than in OAPS&#44; no significant differences were observed&#58; 40&#47;147 &#40;27&#46;21&#37;&#41; vs&#46; 20&#47;61 &#40;32&#46;78&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;4190&#41;&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Obstetric and foetal outcomes</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Obstetric outcomes</span><p id="par0105" class="elsevierStylePara elsevierViewall">No statistically-significant differences were observed in the majority of previous obstetric complications between groups&#44; except for foetal loss which was more frequent in OAPS&#58; OAPS 77&#47;247 &#40;31&#46;2&#37;&#41; vs&#46; OMAPS 14&#47;91 &#40;15&#46;4&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0037&#41;&#46; &#40;<a class="elsevierStyleCrossRef" href="#sec0135">Data depicted in Table A in the <span class="elsevierStyleItalic">attached document 1</span> online version</a>&#46;&#41;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Current obstetric complications appeared in 43&#47;91 &#40;47&#46;25&#37;&#41; cases in OMAPS and 129&#47;247 &#40;52&#46;2&#37;&#41; in OAPS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;4811&#41;&#46; The most commonly observed complication in both groups was prematurity &#40;delivery before 37 weeks at least&#41; and no significant differences in obstetric morbidity were observed between groups despite being the OAPS group older than OMAPS&#46; The authors are concerned about the fact that the unique item that makes the difference between the two main groups is the laboratory criteria&#44; but we decided to compare both groups&#44; in order to analyse possible differences according to the obstetric complications&#46; Comparing cases not fulfilling clinical Sydney criteria between the two whole groups was not possible due to obvious reasons &#40;no patients in OAPS group&#41;&#46; Data comparing current Sydney fulfilling obstetric complications between the whole two groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">All patients in OAPS group &#40;100&#37;&#41; and the majority of patients &#40;67&#46;03&#37;&#41; in the OMAPS group fulfilled clinical Sydney criteria&#46; Although&#44; a not inconsiderable 33&#37; of OMAPS patients did not&#58; all patients in Subgroup A and only 6 patients &#40;8&#46;9&#37;&#41; in Subgroup B&#46; The clinical characteristics of the two OMAPS subgroups are detailed in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Foetal outcomes</span><p id="par0120" class="elsevierStylePara elsevierViewall">Foetal outcomes in OMAPS compared with OAPS are detailed in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; In short&#44; live births were achieved in 71&#47;91 &#40;78&#46;02&#37;&#41; cases in OMAPS vs&#46; 193&#47;247 &#40;78&#46;13&#37;&#41; in OAPS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;9687&#41;&#46; No differences either in the percentage of unsuccessful cases or in the percentage of women treated were observed when the OMAPS and OAPS were compared&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Maternal outcomes</span><p id="par0125" class="elsevierStylePara elsevierViewall">Unfortunately&#44; we had data on puerperal thrombosis in only 49 women in the OMAPS group and 164 in the OAPS group&#46; Gestational venous thromboses were reported in two cases in the OAPS group&#46; No arterial thrombosis was observed&#46; In the puerperal period&#44; thrombosis appeared in 10&#46;20&#37; of cases &#40;5&#47;49&#44; 1 arterial&#44; 4 venous&#41; in OMAPS vs&#46; 8&#46;53&#37; of cases &#40;14&#47;164&#44; 3 arterial&#44; 11 venous&#41; in OAPS&#46; The arterial area involved was the middle cerebral artery in three cases and unknown in the fourth&#46; Women suffering arterial thrombosis were put under Acenocumarol regime&#59; deep venous thromboses in the OMAPS group involved femoral &#40;2 cases&#41; and ilio-femoral &#40;2 cases&#41; areas&#46; Only two of these 5 women suffering puerperal thrombosis in the OMAPS group had received treatment during pregnancy&#58; one with heparin alone and the other with LDA plus heparin&#46; Interestingly&#44; both episodes coincided with the abrupt cessation of heparin and aspirin before completing 6 weeks after delivery&#46; By contrast&#44; all women in the OAPS group who developed arterial &#40;3 cases&#41; and venous thrombosis &#40;11 cases&#41; during the puerperal period had received LDA and heparin&#59; as we have pointed previously women suffering arterial thrombosis received warfarin regimen&#44; and women suffering venous thrombosis were put under anticoagulant doses of LMHW&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Clinical follow-up data were only available from 225 women in OAPS&#44; and 82 in OMAPS&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Interestingly&#44; after 6 month monitoring developments&#44; 7 women in OAPS group met the standard criteria for LUPUS&#59; six of them suffered puerperal thrombosis &#40;2 arterial 4 venous&#41;&#59; 3 women developed other autoimmune diseases&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Data of maternal outcomes according to thrombosis and clinical follow-up are depicted in <a class="elsevierStyleCrossRef" href="#sec0135">Table B in the attached document 1 online version</a>&#46;</p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Analysis of treatment</span><p id="par0145" class="elsevierStylePara elsevierViewall">The major results of therapeutic schedules of the two groups are shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#46; Briefly&#44; 69&#47;91 &#40;75&#46;82&#37;&#41; in the OMAPS vs&#46; 213&#47;247 &#40;86&#46;20&#37;&#41; in the OAPS were started on treatment &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0224&#41;&#46; Interestingly&#44; only 73&#46;91&#37; received the LDA plus heparin combination in the OMAPS&#44; compared to OAPS&#44; 83&#46;09&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46; Only 74&#47;213 &#40;34&#46;7&#37;&#41; vs&#46; 22&#47;69 &#40;31&#46;88&#37;&#41; were put on LDA pre-conceptionally in the OAPS and OMAPS groups&#44; respectively&#46; Daily LDA doses used were 100<span class="elsevierStyleHsp" style=""></span>mg in all treated cases in both groups&#44; and LMWH was used in different schedules&#46; Prophylactic doses of LMWH were administered as follows&#58; low-dose 15&#47;51 &#40;29&#46;41&#37;&#41; and medium-dose in 36&#47;51 &#40;70&#37;&#41;&#46; As in OAPS&#44; the majority of OMAPS cases were treated with LMWH&#44; being enoxaparin the most selected drug&#46; Anti-factor Xa activity was not usually monitored&#46; No drug-related adverse effects&#44; significant heparin-induced thrombocytopenia or thrombocytopenia-thrombosis were reported&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">The overall study population yielded a non-negligible obstetric morbidity rate of 50&#46;88&#37;&#59; specifically&#44; 52&#46;2&#37; in OAPS and 47&#46;3&#37; in OMAPS&#46; According to the different published series&#44; the percentages of early recurrent miscarriage&#44; foetal loss&#47;stillbirth&#44; pre-eclampsia&#44; foetal growth restriction or prematurity in women with OAPS and with incomplete forms &#40;OMAPS&#41; showed a wide variation&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">8&#44;16&#44;17</span></a> In the Registry&#44; when referring to previous pregnancies&#44; miscarriage before 10 weeks proved to be the most prevalent obstetric complication in both groups&#44; followed by foetal loss which was significantly more prevalent in OAPS&#59; in most of those OAPS cases&#44; these fatal complications permitted physicians to correctly diagnose the syndrome and establish the best treatment for further pregnancies&#46; When data related to the current pregnancy were analysed&#44; some percentages changed markedly&#59; however&#44; despite the differences according Sydney clinical criteria observed between groups&#44; statistical significance was not reached&#46; Although the foetal loss rate remained still higher in OAPS&#44; stillbirth showed an inverse correlation and was more prevalent in OMAPS&#44; probably due to successful management of cases with poor previous obstetric outcomes that permitted and early diagnose of the OAPS&#46; Current miscarriage &#8226; and thus&#44; disclosing recurrent miscarriage cases &#8226; complicated 20&#46;93&#37; of OMAPS pregnancies and 16&#46;27&#37; of OAPS&#46; Prematurity &#40;defined as delivery at least before 37 weeks of pregnancy&#41; with no other apparent cause but placental failure was the most prevalent obstetric outcome in both groups&#44; followed by foetal loss in OAPS and severe early-onset PE in OMAPS&#46; Since that other causes of prematurity were ruled out&#44; a potential relationship between aPL and prematurity should be considered&#46; The majority of women with an OMAPS did not fulfil the APS laboratory criteria&#46; Only 26&#46;37&#37; of OMAPS women repeatedly tested positive for one or more aPL&#44; but did not met the clinical criteria&#46; In this subgroup&#44; the laboratory results and distribution of the different laboratory categories did not differ significantly from those of the OAPS group&#44; as expected&#46; This observation raises the question of whether aPL should be sought in women with hidden OAPS in which a timely correct treatment would avoid worse clinical outcomes&#46; Forastiero<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> reported a relationship between obstetric complications and diverse aPL types and titres&#44; some of which are not included as markers for OAPS&#44; and suggested that other forms of aPL&#44; other than the classical&#44; should be considered in the laboratory criteria&#44; and other authors concur&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">7&#8226;9</span></a> Chighizola et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> in a systematic review&#44; reported a positive association between aPL and diverse obstetric complications&#44; some of which are not included in the Sydney obstetric morbidity criteria&#46; Laboratory results in the OAPS group were similar to the data published elsewhere<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a> for all aPL categories and isotypes&#46; According to the Registry laboratory results&#44; significant differences among the different laboratory categories were observed between OAPS and OMAPS groups&#46; Although these women did not fulfil the laboratory Sydney requirements&#44; we decided to classify them as &#8220;incomplete&#8221; laboratory results as in OAPS&#46; Thus&#44; our results demonstrate that all aPL categories and isotypes should be considered together to yield more information leading to optimum management of these women&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In the Registry&#44; no women suffered demonstrable thrombosis during pregnancy&#44; and only 14 and 5 women suffered puerperal thrombosis in the OAPS and OMAPS groups&#44; respectively&#46; These results reinforce the hypothesis that certain cases will have only obstetric complications with few or no thrombotic events&#44; other than placental&#44; episodes over time&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">2&#44;23&#44;24</span></a> Moreover&#44; it is worth mentioning that inherited thrombophilia is not considered to be a risk factor or have an association with OAPS&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">25</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">A considerable percentage of women in both group were put under treatment&#44; while significantly higher in OAPS group&#46; The combination of LDA and LMWH was widely used in both groups&#44; and good maternal and foetal outcomes in both groups were observed when treated&#46; Although&#44; almost 17&#37; of OAPS women did not receive the recommended schedule&#46; Moreover&#44; in light of the recent data on aPL-related obstetric pathology&#44; we believe treatment should be started as early as possible&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">26&#44;27</span></a> Interestingly LDA before pregnancy and LDA plus LMWH during pregnancy was administered only in less than one-third of cases&#46; Based on the morbidity rates&#44; it is clear that our therapeutic approaches need to be improved&#46; We highlight that the live birth rate was quite acceptable in both groups&#44; but higher in the OAPS treated group than in OMAPS treated group&#46; Thus&#44; we should conclude that improving therapeutic approach would bring with better outcomes in both groups&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The Registry has some weak points&#46; First of all&#44; the inclusion of methods that merge retrospective and prospective cases could raise concerns for data analysis and therefore&#44; to avoid them&#44; only the data of the latest pregnancy of each woman were fully analysed&#46; When a woman already included in the registry added another current pregnancy&#44; database automatically send the last episode as a previous one&#46; Secondly&#44; aPL test results were difficult to interpret in certain cases since different commercial and home-made methods were used&#46; Conversely&#44; the inclusion of laboratory data from different centres could also prevent a possible bias attributable to one or few laboratories&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">No all the cases were sent or recruited with full information about embryo-foetal or parental karyotype in RM of foetal loss&#44; clinical or laboratory items such congenital thrombophilia or puerperal follow-up&#46; Moreover&#44; the retrospective data&#44; are more used to lose information&#44; mostly in some cases with no current episode&#44; but previous only&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Regarding the strong points&#44; the number of obstetric APS cases studied &#40;OAPS&#41; and &#8220;incomplete APS&#8221; women &#40;OMAPS&#41; with more than 1000 historical episodes represents one of the largest series in this field&#46; Finally&#44; the inclusion of patients from multiple centres enriches the Registry and minimises any bias that may arise when results are provided by a single centre&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conclusion</span><p id="par0180" class="elsevierStylePara elsevierViewall">No differences in clinical complications and maternal and foetal outcomes were observed when the two groups of this Registry were compared&#46; Recurrent first trimester miscarriage followed by foetal loss plus stillbirth and early onset preeclampsia were the most common obstetric morbidities in this cohort&#46; Interestingly&#44; inter-group differences in laboratory categories were observed&#44; with category II being more frequent in the OMAPS group and category I in the OAPS group&#46; Maternal and foetal outcomes were good when the currently recommended treatment was given&#46; Indeed&#44; the lack of differences between complete and incomplete forms reinforces the attitude of some experts that this last group of women could have the same risk as those suffering OAPS&#46; Thus&#44; they deserve a similar management to OAPS patients&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Nevertheless&#44; further research into the OMAPS forms is required for better understanding of the main pathophysiological pathways involved and possible new laboratory markers&#46; Considering that the reported prevalence of aPL is relatively high and heterogeneous in the general population&#44; it is possible that aPL variations through pregnancy and that preliminary data revealing the value of other aPL levels&#44; types and isotypes not yet included in the Sydney criteria are increasing&#59; we agree with several authors who claimed that the current classification criteria are too restrictive for the Obstetric Antiphospholipid Syndrome and therefore many women are left undiagnosed and untreated&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conflicts of interest</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Patient baseline clinical characteristics"
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              "titulo" => "Laboratory characteristics and obstetrics-related morbidities"
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              "titulo" => "Obstetric and foetal outcomes"
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    "fechaRecibido" => "2017-04-30"
    "fechaAceptado" => "2017-11-09"
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            0 => "Antiphospholipid antibody"
            1 => "Antiphospholipid syndrome"
            2 => "Obstetric morbidity&#44; Incomplete obstetric antiphospholipid syndrome"
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            0 => "Anticuerpos antifosfol&#237;pido"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To compare clinical&#44; laboratory&#44; treatment and live birth rate data between women with aPL-related obstetric complications &#40;OMAPS&#41; not fulfilling the Sydney criteria and women fulfilling them &#40;OAPS&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective and prospective multicentre study&#46; Data comparison between groups from The European Registry on Antiphospholipid Syndrome included within the framework of the European Forum on Antiphospholipid Antibody projects&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">338 women were analysed&#58; 247 fulfilled the Sydney criteria &#40;OAPS group&#41; and 91 did not &#40;OMAPS group&#41;&#46; In the OMAPS group&#44; 24&#47;91 &#40;26&#46;37&#37;&#41; fulfilled laboratory Sydney criteria &#40;subgroup A&#41; and 67&#47;91 &#40;74&#46;63&#37;&#41; had a low titre and&#47;or non-persistent aPL-positivity &#40;subgroup B&#41;&#46; Overall&#44; aPL laboratory categories in OAPS vs&#46; OMAPS showed significant differences&#58; 34&#37; vs&#46; 11&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; for category I&#44; 66&#37; vs&#46; 89&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; for category II&#46; No differences were observed when current obstetric complications were compared &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;481&#41;&#46; 86&#46;20&#37; of OAPS women were treated vs&#46; 75&#46;82&#37; of OMAPS &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0224&#41;&#44; particularly regarding the LDA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>LMWH schedule &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46; No differences between groups were observed in live births&#44; gestational&#44; puerperal arterial and&#47;or venous thrombosis&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Significant differences were found among aPL categories between groups&#46; Treatment rates were higher in OAPS&#46; Both OAPS and OMAPS groups had similarly good foetal-maternal outcomes when treated&#46; The proposal to modify OAPS classification criteria&#44; mostly laboratory requirements&#44; is reinforced by these results&#46;</p></span>"
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            "titulo" => "Materials and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento Y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparar caracter&#237;sticas cl&#237;nicas&#44; anal&#237;ticas&#44; tratamiento y tasa de hijos vivos entre gestantes con S&#237;ndrome Antifosfol&#237;pido Obst&#232;c&#41;trico &#40;SAFO&#41; y gestantes con morbilidad obst&#232;c&#41;trica relacionada con el s&#237;ndrome que no cumplen los criterios de clasificaci&#243;n actuales&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material Y m&#232;c&#41;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo y prospectivo multic&#232;c&#41;ntrico&#58; datos de once hospitales terciarios europeos recogidos en el European Registry on Antiphospholipid Syndrome&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 338 mujeres&#58; 247 cumpl&#237;an criterios de Sydney para SAFO &#40;grupo OAPS&#41;&#44; y 91 no &#40;grupo OMAPS&#41;&#46; En el grupo OMAPS&#44; 24&#47;91&#40;26&#46;37&#37;&#41; cumpl&#237;an criterios anal&#237;ticos&#44; pero no cl&#237;nicos para SAFO &#40;subgrupo A&#41; y 67&#47;91&#40;74&#46;63&#37;&#41; presentaban t&#237;tulos medio-bajos o t&#237;tulos positivos no persistentes de anticuerpos antifosfol&#237;pido&#44; con o sin cumplir criterios cl&#237;nicos &#40;subgrupo B&#41;&#46; Se observaron diferencias significativas entre los 2 grupos en cuanto a las categor&#237;as anal&#237;ticas&#58; 34&#37; vs&#46; 11&#37; &#40;p&#60;0&#46;0001&#41; para la categor&#237;a I y 66&#37; vs&#46; 89&#37; &#40;p&#60;0&#46;0001&#41; para la categor&#237;a II&#44; OAPS vs OMAPS&#44; respectivamente&#46; No se observaron diferencias significativas en cuanto a las complicaciones obst&#232;c&#41;tricas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;481&#41;&#46; El 86&#46;20&#37; del grupo OAPS recibi&#243; tratamiento vs&#46;el 75&#46;82&#37; del grupo OMAPS &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0224&#41;&#46; No se observaron diferencias en la tasa de hijos vivos&#44; ni en la tasa de trombosis arterial y&#47;o venosa gestacional y&#47;o puerperal&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ambos grupos fueron muy homog&#232;c&#41;neos&#44; excepto en cuanto a la distribuci&#243;n de las categor&#237;as anal&#237;ticas y en la tasa de tratamiento&#46; Ambos grupos mostraron buenos resultados al ser tratados&#46; Los resultados respaldan la opini&#243;n de muchos expertos de tener que revisar los criterios de clasificaci&#243;n actuales del S&#237;ndrome Antifosfol&#237;pido Obst&#232;c&#41;trico&#46;</p></span>"
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            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0135"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of patients in the two OMAPS subgroups&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Chi-square test and Mann&#8226;Whitney&#8226;Wilcoxon <span class="elsevierStyleItalic">U</span> test&#59; BMI&#58; body mass index&#59; OAPS&#58; obstetric antiphospholipid syndrome&#59; OMAPS&#58; obstetric morbidity related to antiphospholipid antibodies&#59; SLE&#58; systemic lupus erythematosus&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>247&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>91&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;71 &#40;7&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0040</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Ethnicity &#40;n&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>African&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="6" align="char" valign="top">0&#46;3005</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>American&#47;Caribbean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Latino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;3&#46;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;59&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Asian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Caucasian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">220 &#40;89&#46;06&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;83&#46;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Jewish&#47;Arab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;4&#46;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;7&#46;69&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Smoker &#40;n&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;21&#46;97&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9958&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">BMI mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;0 &#40;3&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;4 &#40;4&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">S&#46;L&#46;E</span>&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;5&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0637&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Other autoimmune diseases</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;10&#46;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;12&#46;08&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7652&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Inherited thrombophilia&#40;n&#47;N&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#47;145 &#40;26&#46;89&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#47;58 &#40;34&#46;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2822&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics and main general data of two groups&#46;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Laboratory category&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>247&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleUnderline">I</span> &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#47;247 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;91 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Double &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#47;247 &#40;23&#46;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;91 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0011</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>aCL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#47;247 &#40;10&#46;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;91 &#40;2&#46;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0172</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LA<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>anti&#946;2GPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;247 &#40;2&#46;83&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#47;91 &#40;0&#46;00&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1962&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">aCL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>anti&#946;2GPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#47;247 &#40;10&#46;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;91 &#40;5&#46;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1551&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triple&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#47;247 &#40;10&#46;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;91 &#40;3&#46;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0353</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleUnderline">II</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">163&#47;247 &#40;65&#46;99&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&#47;91 &#40;89&#46;01&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIa &#40;LA&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#47;247 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;91 &#40;7&#46;69&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0310</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIb &#40;aCL&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#47;247 &#40;26&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&#47;91 &#40;43&#46;95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0025</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgG&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#47;247 &#40;12&#46;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#47;91 &#40;23&#46;07&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0174</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgM&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#47;247 &#40;4&#46;85&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#47;91 &#40;16&#46;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0005</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgG&#43; &#38; IgM&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#47;247 &#40;9&#46;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#47;91 &#40;4&#46;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1392&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IIc &#40;anti&#946;2GPI&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#47;247 &#40;22&#46;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#47;91 &#40;37&#46;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0052</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgG&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#47;247 &#40;6&#46;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#47;91 &#40;18&#46;68&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0&#46;0008</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgM&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#47;247 &#40;6&#46;07&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#47;91 &#40;9&#46;89&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2255&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IgG&#43;&#38; IgM&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#47;247 &#40;9&#46;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#47;91 &#40;8&#46;79&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7966&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">FGR&#58; foetal growth restriction &#40;retardation&#41;&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Obstetrical complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>247&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&#47;247 &#40;47&#46;77&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;52&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4811&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">129 &#40;52&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;47&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recurrent miscarriage &#40;current episode&#41; &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#47;129 &#40;16&#46;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#47;43 &#40;20&#46;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Foetal loss &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#47;129 &#40;17&#46;82&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;43 &#40;11&#46;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stillbirth &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;129 &#40;8&#46;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;43 &#40;16&#46;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1588&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Foetal loss &#38; stillbirth&#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#47;129 &#40;26&#46;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#47;43 &#40;27&#46;90&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8423&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prematurity &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#47;129 &#40;47&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#47;43 &#40;34&#46;88&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8590&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early-onset PE<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prematurity &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#47;129 &#40;13&#46;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;43 &#40;23&#46;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HELLP<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prematurity &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;129 &#40;5&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;43 &#40;11&#46;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1775&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early FGR<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prematurity &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#47;129 &#40;13&#46;95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;43 &#40;16&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7079&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Early-onset PE&#47;HELLP<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>FGR<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>prematurity &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#47;129 &#40;11&#46;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;43 &#40;16&#46;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5310&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abruptio placentae &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#47;129 &#40;3&#46;87&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;43 &#40;4&#46;65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Late-Onset PE &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#47;129 &#40;12&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;43 &#40;16&#46;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Placenta haematoma &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;129 &#40;0&#46;77&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;43 &#40;4&#46;65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1546&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Late IUGR &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#47;129 &#40;1&#46;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;43 &#40;2&#46;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1874014.png"
              ]
            ]
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Chi-square test or Fisher&#39;s exact test&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Current pregnancy obstetrical complications in OAPS and OMAPS groups&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Chi-square test&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Live births&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>247&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;<br>Treatment<br>No treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">193&#47;247 &#40;78&#46;13&#37;&#41;<br>175&#47;193 &#40;90&#46;67&#37;&#41;<br>18&#47;193 &#40;9&#46;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#47;91 &#40;78&#46;02&#37;&#41;<br>58&#47;71 &#40;81&#46;69&#37;&#41;<br>13&#47;71 &#40;18&#46;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9687<br><span class="elsevierStyleBold">0&#46;0444</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;<br>Treatment<br>No treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">55&#47;247 &#40;22&#46;26&#37;&#41;<br>38&#47;55 &#40;69&#37;&#41;<br>17&#47;55 &#40;30&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#47;91 &#40;21&#46;97&#37;&#41;<br>11&#47;20 &#40;55&#37;&#41;<br>9&#47;20 &#40;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;00<br>0&#46;2568&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Live births and treatment in OAPS and OMAPS group&#46;</p>"
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      5 => array:8 [
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        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Chi-square test or Fisher&#39;s exact test&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OAPS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>247&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OMAPS&#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#47;247 &#40;13&#46;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#47;91 &#40;24&#46;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleBold">0&#46;0224</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">213&#47;247 &#40;86&#46;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69&#47;91 &#40;75&#46;82&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDA previous pregnancy &#40;LDApp&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#47;247 &#40;29&#46;95&#37;&#41;<br>74&#47;213 &#40;34&#46;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;1277<br>0&#46;3146&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;247 &#40;3&#46;23&#37;&#41;<br>8&#47;213 &#40;3&#46;75&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;1143<br>0&#46;2060&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 23870206
Original language: English

DOI:10.1016/j.medcle.2017.11.052

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