ANTIPHOSPHOLIPID ANTIBODY SEROPREVALENCE AND ITS ASSOCIATION WITH PREGNANCY LOSS AMONG WOMEN IN SANA'A CITY, YEMEN: A PROSPECTIVE CASE-CONTROL STUDY

Abstract

Background: Antiphospholipid syndrome (APS) is a leading cause of recurrent pregnancy loss in women of reproductive age. Data from conflict-affected low-resource settings such as Yemen remain scarce.

Objectives: To determine the seroprevalence of antiphospholipid antibodies (aPL-IgG) in women with and without pregnancy loss in Sana'a City, Yemen, and to evaluate associated clinical and epidemiological factors.

Methods: A prospective case-control study was conducted between January and May 2022 at three public and private hospitals in Sana'a. A total of 101 pregnant women were enrolled: 62 cases (women with pregnancy loss) and 39 controls (women without pregnancy loss). Serum antiphospholipid antibodies (IgG and IgM) against cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidic acid, and beta-2-glycoprotein I were detected by a validated ELISA kit with a cut-off of ≥10 GPL-U/ml for IgG positivity.

Results: aPL-IgG positivity was detected in 19.4% of cases and 0% of controls (corrected OR = 19.6; 95% CI: 1.1–348.0; p = 0.003). All 12 seropositive participants were in the first trimester. Cases were significantly older (29.8 ± 5.9 vs. 25.8 ± 5.7 years; p = 0.001) and had significantly earlier gestational age at presentation. Among aPL-positive cases, 91.7% used aspirin and 33.3% used heparin. Assay validation demonstrated high analytical performance: sensitivity 91.8%, specificity 97.3%, and coefficient of variation <6% for IgG.

Conclusions: aPL-IgG positivity is significantly associated with pregnancy loss in Yemeni women. The high prevalence in the first trimester underscores the need for early aPL screening. Large-scale, multi-center prospective studies with confirmatory testing are urgently required.