{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:04:16Z","timestamp":1780639456789,"version":"3.54.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>To assess the prevalence and clinical impact of antinuclear antibodies (ANA) and low complement levels on fetal\u2013maternal outcomes in pregnant women within the spectrum of obstetric antiphospholipid syndrome (APS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 285 ever-pregnant women with APS-related obstetric morbidity were included. Among them, 85 fulfilled APS classification criteria, 139 were classified as non-criteria APS (NC-APS), and 61 as seronegative APS (SN-APS). Patients with other autoimmune diseases were excluded. Adverse pregnancy outcomes (APO) included early pregnancy loss, fetal death, preeclampsia, abruptio placentae, and preterm birth. Successful pregnancy was defined as the achievement of a live birth. ANA positivity and complement levels were analyzed in relation to obstetric outcomes and treatment prescription patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty patients (22.3%) were ANA positive. ANA positivity was associated with a lower number of pregnancies and live births, with the lowest ANA titers observed in the SN-APS group. Fifteen patients (6.3%) presented low complement levels. Hypocomplementemia was associated with a higher incidence of preeclampsia and early miscarriages, particularly among NC-APS patients. Additionally, all serological abnormalities were significantly associated with increased prescription of antimalarial therapy during pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>ANA positivity and hypocomplementemia were associated with poorer obstetric outcomes in women within the spectrum of obstetric APS. These serological abnormalities may identify a subgroup of patients with a higher-risk obstetric profile and greater need for intensified therapeutic management, including the use of antimalarial treatment during pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1818605","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:37:27Z","timestamp":1780637847000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of antinuclear antibodies and complement levels in the prognosis of pregnant women within the antiphospholipid syndrome spectrum"],"prefix":"10.3389","volume":"17","author":[{"given":"Sara Garcia","family":"Bravo","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Hospital Marqu\u00e9s de Valdecilla","place":["Santander, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00edctor M.","family":"Mart\u00ednez-Taboada","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Hospital Marqu\u00e9s de Valdecilla","place":["Santander, Spain"]},{"name":"Departamento de Medicina y Psiquiatr\u00eda, Universidad de Cantabria","place":["Santander, Spain"]},{"name":"Immunopathology Group, Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IDIVAL)","place":["Santander, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"del Barrio-Longarela","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Gynecology, Hospital Marqu\u00e9s de Valdecilla","place":["Santander, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Merino","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Gynecology, Hospital Marqu\u00e9s de Valdecilla","place":["Santander, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Comins-Boo","sequence":"additional","affiliation":[{"name":"Immunopathology Group, Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IDIVAL)","place":["Santander, Spain"]},{"name":"Division of Obstetrics and Gynecology, Hospital Marqu\u00e9s de Valdecilla","place":["Santander, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos","family":"L\u00f3pez-Hoyos","sequence":"additional","affiliation":[{"name":"Immunopathology Group, Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IDIVAL)","place":["Santander, Spain"]},{"name":"Immunology Department, Hospital Universitario Marqu\u00e9s de Valdecilla","place":["Santander, Spain"]},{"name":"Departamento de Biolog\u00eda Molecular. Universidad de Cantabria","place":["Santander, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 L.","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Departamento de Medicina y Psiquiatr\u00eda, Universidad de Cantabria","place":["Santander, Spain"]},{"name":"Immunopathology Group, Instituto de Investigaci\u00f3n Marqu\u00e9s de Valdecilla (IDIVAL)","place":["Santander, Spain"]},{"name":"Department of Internal Medicine, Hospital Marqu\u00e9s de Valdecilla","place":["Santander, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1111\/j.1538-7836.2006.01753.x","article-title":"International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)","volume":"4","author":"Miyakis","year":"2006","journal-title":"J Thromb Haemostasis"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kez419","article-title":"Comparative study of obstetric antiphospholipid syndrome (OAPS) and non-criteria obstetric APS (NC-OAPS): Report of 1640 cases from the EUROAPS registry","volume":"59","author":"Alijotas-Reig","year":"2020","journal-title":"Rheumatol (United Kingdom)"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1177\/26335565221096584","article-title":"Association between pre-pregnancy multimorbidity and adverse maternal outcomes: A systematic review","volume":"12","author":"Brown","year":"2022","journal-title":"J Multimorbidity Comorbidity"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5684","article-title":"Maternal thyroid disease and its effects on the fetus and perinatal outcomes","volume":"40","author":"Huget-Penner","year":"2020","journal-title":"Prenat Diagn"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1017\/S2040174420001051","article-title":"Pregnancy outcomes in women with preexisting thyroid diseases: A French cohort study","volume":"12","author":"Lecorguill\u00e9","year":"2020","journal-title":"J Dev Orig Health Dis"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10056","article-title":"Reproductive outcomes in women with congenital uterine anomalies: A systematic review","volume":"38","author":"Chan","year":"2011","journal-title":"Ultrasound Obstetrics Gynecology"},{"key":"B7","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/S1521-6934(03)00010-5","article-title":"The inherited thrombophilias: Genetics, epidemiology, and laboratory evaluation","volume":"17","author":"Buchanan","year":"2003","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/FIMMU.2024.1361062","article-title":"Four clinical and biological phenotypes in antiphospholipid syndrome: a cluster analysis of 174 patients with antinuclear antibody tests","volume":"15","author":"Ottavi","year":"2024","journal-title":"Front Immunol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2021.105297","article-title":"Clinical and prognostic significance of antinuclear antibodies in primary antiphospholipid syndrome: A multicenter retrospective study","volume":"89","author":"Ricard","year":"2022","journal-title":"Joint Bone Spine"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1093\/RHEUMATOLOGY\/KEAE583","article-title":"ANA-positive versus ANA-negative antiphospholipid antibody-positive patients: Results from the Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) Clinical Database and Repository (\u201cRegistry\u201d)","volume":"64","author":"Cecchi","year":"2025","journal-title":"Rheumatology"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/FPHAR.2022.841785","article-title":"Beyond systemic lupus erythematosus and anti-phospholipid syndrome: The relevance of complement from pathogenesis to pregnancy outcome in other systemic rheumatologic diseases","volume":"13","author":"Cavalli","year":"2022","journal-title":"Front Pharmacol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.placenta.2023.04.001","article-title":"Low complement levels are related to poor obstetric outcomes in women with obstetric antiphospholipid syndrome. 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