{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:55:23Z","timestamp":1790920523160,"version":"4.1.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"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. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize the clinical, serologic, and treatment features of patients with obstetric antiphospholipid syndrome (OAPS), determine the proportion meeting the laboratory domain of the 2023 American College of Rheumatology\/European Alliance of Associations for Rheumatology (ACR\/EULAR) classification criteria, and examine patients identified through non-criteria antibodies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed consecutive women with a prior clinical diagnosis of OAPS at our center and assigned de-identified codes P1-P45. Of the 45 patients, 41 had sufficiently complete historical serologic documentation for laboratory-domain reclassification; P10, P17, P34 and P42 were retained in the descriptive cohort but treated as not assessable in the evaluable-case analysis. Two investigators independently scored each evaluable patient across the six clinical domains and two laboratory domains; classification required a cumulative score of \u22653 in both the clinical and laboratory domains. For patients with concomitant systemic lupus erythematosus (SLE), obstetric or hematologic manifestations attributable to SLE were excluded from APS scoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 45 patients were included, all female, with a mean age of 33.7 years (43 primary APS, 2 SLE-associated). Thirty-two patients (71.1%) had a history of pregnancy loss, and 20 had recurrent miscarriage. Anticardiolipin (aCL) IgG and IgM were positive in 9 and 14 patients, respectively; anti-\n                      <jats:italic>\u03b2<\/jats:italic>\n                      2-glycoprotein I (anti-\n                      <jats:italic>\u03b2<\/jats:italic>\n                      2GPI) IgG and IgM were positive in 2 and 16 patients, respectively; lupus anticoagulant (LAC) was positive in 2 patients. Fourteen patients (31.1%) carried non-criteria antibodies, including 7 with non-criteria antibodies only. Among the 41 patients with evaluable serologic data, 7\/41 (17.1%) definitively met the \u22653-point laboratory threshold and 11\/41 (26.8%) met it under the upper-bound assumptions. In the conservative sensitivity analysis, which counted P10, P17, P34 and P42 as below threshold, the corresponding estimates were 7\/45 (15.6%) and 11\/45 (24.4%). Patients with isolated IgM positivity, IgA-only antibodies, single-positive LAC, or non-criteria antibodies alone did not meet the threshold. An exploratory comparison found no statistically significant difference in documented standardized intervention between live-birth and further-loss cases [28\/36 [77.8%] vs 6\/9 [66.7%]; two-sided Fisher's exact\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.666].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this single-center retrospective series of 45 patients, many patients were identified through non-criteria antibodies or low-weight serologic profiles and therefore did not meet the 2023 laboratory-domain threshold. Because of the small sample, these findings are descriptive and hypothesis-generating and should not be generalized. Nevertheless, they support using the 2023 criteria primarily to define homogeneous research cohorts rather than as a stand-alone basis for diagnosis or treatment decisions. Whether the obstetric phenotype requires a separate classification approach remains to be determined.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1929786","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:35:19Z","timestamp":1790919319000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Reclassification of obstetric antiphospholipid syndrome under the 2023 ACR\/EULAR criteria: risk of under-recognition in patients with non-criteria antibodies and clinical implications"],"prefix":"10.3389","volume":"13","author":[{"given":"Tingwei","family":"Sheng","sequence":"first","affiliation":[{"name":"Department of Encephalopathy, Hubei Provincial Hospital of Traditional Chinese Medicine","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqi","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengwei","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Encephalopathy, Hubei Provincial Hospital of Traditional Chinese Medicine","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoding","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,2]]},"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 Haemost"},{"key":"B2","doi-asserted-by":"publisher","first-page":"17103","DOI":"10.1038\/nrdp.2017.103","article-title":"Antiphospholipid syndrome","volume":"4","author":"Schreiber","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2010","DOI":"10.1056\/NEJMra1705454","article-title":"Diagnosis and management of the antiphospholipid syndrome","volume":"378","author":"Garcia","year":"2018","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1177\/0961203309106832","article-title":"The euro-phospholipid project: epidemiology of the antiphospholipid syndrome in Europe","volume":"18","author":"Cervera","year":"2009","journal-title":"Lupus"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1002\/art.40901","article-title":"The epidemiology of antiphospholipid syndrome: a population-based study","volume":"71","author":"Duarte-Garc\u00eda","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/j.autrev.2018.12.006","article-title":"The European registry on obstetric antiphospholipid syndrome (EUROAPS): a survey of 1000 consecutive cases","volume":"18","author":"Alijotas-Reig","year":"2019","journal-title":"Autoimmun Rev"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1136\/ard-2023-224609","article-title":"The 2023 ACR\/EULAR antiphospholipid syndrome classification criteria","volume":"82","author":"Barbhaiya","year":"2023","journal-title":"Ann Rheum Dis"},{"key":"B8","doi-asserted-by":"publisher","first-page":"115055","DOI":"10.1016\/j.ejogrb.2026.115055","article-title":"Impact of the 2023 ACR\/EULAR antiphospholipid syndrome criteria in 1200 women with prior obstetric antiphospholipid syndrome","volume":"321","author":"Alijotas-Reig","year":"2026","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1002\/art.42835","article-title":"A diagnostic performance study of the 2023 ACR\/EULAR classification criteria for patients with antiphospholipid syndrome from the antiphospholipid syndrome Chinese collaborative cohort presenting with suspected antiphospholipid syndrome","volume":"76","author":"Lu","year":"2024","journal-title":"Arthritis Rheumatol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"103237","DOI":"10.1016\/j.jaut.2024.103237","article-title":"Assessment of the 2023 ACR\/EULAR antiphospholipid syndrome classification criteria in a Chinese cohort: impact on clinical practice","volume":"146","author":"Yang","year":"2024","journal-title":"J Autoimmun"},{"key":"B11","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1111\/jth.13976","article-title":"Laboratory criteria for antiphospholipid syndrome: communication from the SSC of the ISTH","volume":"16","author":"Devreese","year":"2018","journal-title":"J Thromb Haemost"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1306","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":"Rheumatology (Oxford)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.3390\/diagnostics14192162","article-title":"Impact of the 2023 ACR\/EULAR classification criteria in women with primary antiphospholipid syndrome during pregnancy","volume":"14","author":"Mart\u00ednez-Taboada","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/acr.80040","article-title":"Assessing the sensitivity and the clinical impact of the 2023 American College of Rheumatology\/EULAR classification criteria in obstetric antiphospholid syndrome: findings from a multicenter Italian cohort with a long-term follow-up","author":"Ruffilli","year":"2026","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1660","DOI":"10.1016\/j.jtha.2024.02.019","article-title":"Performance validation of the 2023 ACR\/EULAR antiphospholipid syndrome classification criteria in an antiphospholipid syndrome cohort","volume":"22","author":"Zhao","year":"2024","journal-title":"J Thromb Haemost"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1002\/art.42957","article-title":"Performance of the 2023 ACR\/EULAR classification criteria for antiphospholipid syndrome in a Mexican cohort","volume":"76","author":"Cim\u00e9-Ak\u00e9","year":"2024","journal-title":"Arthritis Rheumatol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e4","DOI":"10.1136\/ard-2023-225013","article-title":"Correspondence on \u20182023 ACR\/EULAR antiphospholipid syndrome classification criteria\u2019","volume":"83","author":"Tang","year":"2024","journal-title":"Ann Rheum Dis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1016\/j.thromres.2015.08.019","article-title":"The clinical relevance of the IgM isotype of antiphospholipid antibodies in the vascular antiphospholipid syndrome","volume":"136","author":"Del Ross","year":"2015","journal-title":"Thromb Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1160\/TH13-06-0509","article-title":"Anti-prothrombin (aPT) and anti-phosphatidylserine\/prothrombin (aPS\/PT) antibodies and the risk of thrombosis in the antiphospholipid syndrome. A systematic review","volume":"111","author":"Sciascia","year":"2014","journal-title":"Thromb Haemost"},{"key":"B20","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1055\/s-0040-1705115","article-title":"Antiphosphatidylserine\/prothrombin antibodies: an update on their association with clinical manifestations of antiphospholipid syndrome","volume":"120","author":"Radin","year":"2020","journal-title":"Thromb Haemost"},{"key":"B21","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.thromres.2022.04.021","article-title":"Prevalence of antiphosphatidylserine\/prothrombin antibodies and association with antiphospholipid antibody profiles in patients with antiphospholipid syndrome: a systematic review and meta-analysis","volume":"214","author":"Zhu","year":"2022","journal-title":"Thromb Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e001174","DOI":"10.1136\/lupus-2024-001174","article-title":"Non-criteria antiphospholipid antibody profiles and thrombotic outcomes in a cohort of patients with systemic lupus erythematosus","volume":"11","author":"Murray","year":"2024","journal-title":"Lupus Sci Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"100134","DOI":"10.1016\/j.jtauto.2021.100134","article-title":"Role of antiphospholipid antibodies in the diagnosis of antiphospholipid syndrome","volume":"4","author":"Devreese","year":"2021","journal-title":"J Transl Autoimmun"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1136\/annrheumdis-2019-215213","article-title":"EULAR recommendations for the management of antiphospholipid syndrome in adults","volume":"78","author":"Tektonidou","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1182\/blood-2013-08-522623","article-title":"Comparative incidence of pregnancy outcomes in treated obstetric antiphospholipid syndrome: the NOH-APS observational study","volume":"123","author":"Bouvier","year":"2014","journal-title":"Blood"},{"key":"B26","doi-asserted-by":"publisher","first-page":"hoad002","DOI":"10.1093\/hropen\/hoad002","article-title":"ESHRE guideline: recurrent pregnancy loss: an update in 2022","volume":"2023","author":"Bender Atik","year":"2023","journal-title":"Hum Reprod Open"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1929786\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:35:20Z","timestamp":1790919320000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1929786\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,2]]},"references-count":26,"alternative-id":["10.3389\/fmed.2026.1929786"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1929786","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,2]]},"article-number":"1929786"}}