Association of Antinuclear Antibodies in Pregnant Women with Bad Obstetric History.

INTRODUCTION : Immune status, individual response to disease and types of antibodies produced are known to vary from person to person, place to place and from population to population. A broad spectrum of specific auto antibodies which are associated with specific rheumatic diseases, as noted in Western literature, has been taken as a reference standard all over the world1. There is neither research work nor any data correlating the auto antibodies and their antinuclear antibody (ANA) patterns with the immune profile in the Indian population to date. The term Bad Obstetric History(BOH)3,” is applied to pregnant women where her present obstetric outcome is likely to be affected adversely by the nature of previous obstetric disaster”. In obstetrics, any complicating factor, known or unknown is likely to recur and if it recurs in two consecutive pregnancies, the chance of its recurrence in third pregnancy is highly probable. AIMS AND OBJECTIVES : 1. To find out the prevalence of antinuclear antibodies in pregnant women with bad obstetric history against healthy multiparous women in and around Tirunelveli district. 2. To evaluate the utility of Indirect immunofluorescence using HEp-2 cells in the diagnosis of autoantibodies (Anti Nuclear Antibodies). 3. To compare the efficacy of immunoflorescence test and ELISA for diagnosis and interpretation of pregnant women with bad obstetric history. MATERIALS AND METHODS : The present study was conducted from the period of August 2011 to September 2012. The study population comprises mainly of pregnant women from 19-40 years, attending Antenatal clinic and inpatients in Obstetrics and Gynaecology Department, Tirunelveli Medical College Hospital. This is a case-control study comprising of equal number of cases and controls, each comprising 60 women of reproductive age group. The study population comprises of 60 pregnant women from age group 19-40 years. With history of 2 or more spontaneous abortions. It also includes women with past history of still-births, intra-uterine death or early neonatal deaths. The population was carefully selected that women in study group has no live issues. The control group comprises of 60 multiparous pregnant women from age group 19-40 years, with no history of abortions. Exclusion criteria: This group was carefully selected to exclude women: history of heart disease, anaemia,renal failure, history of Rh-incompatability, history of sexually transmitted diseases, or TORCH infections, history of uterine fibroids, endometriosis, PID, uterine, anomalies- septate uterus, bicornuate uterus. RESULTS : Data regarding the cases and controls were described in terms of percentages. Sensitivity, specificity, positive predictive value, negative predictive value of ELISA was done. The cases and controls were statistically analysed for significance by Chi-squared test. The Chi-squared test was calculated for the analytic assessment by SPSS 20 version software. The differences were considered to be statistically significant when the p value obtained was less than 0.05. Thus women without an autoimmune disorder history, but with complications during pregnancy, have a raised number of auto antibodies. This may be due to exacerbation of an undiagnosed autoimmune disorder or an unknown maternal immune reaction. It is not known whether the occurrence of autoantibodies, is transient and limited to pregnancy and immediate postpartum period, or it is predictive of future immunological disease. CONCLUSION : The present study shows that autoantibodies play a role in recurrent pregnancy loss; and patients with bad obstetric history should be evaluated for antinuclear antibodies. Since abortions due to immune causes occurs in late 1st trimester or early mid-trimester, patients should be screened as early as possible. Women who presents with hypothyroidism, hypertension, diabetes mellitus in pregnancy tend to have an associated antinuclear antibody, so these patients also to be evaluated. Normal pregnant women have autoantibodies, probably due to some cross-infections which interferes with test result. Indirect Immunofluorescence is superior to identify antinuclear antibodies directed against nuclear antigens. ELISA appears to be a screening procedure to rule out negative samples. It is easy to perform, accurate, with least interpersonal variations and can be used to screen large population. Samples with borderline results are to be confirmed by other methods. Immunofluorescence is superior, because it can identify different patterns, which are specific for certain diseases, which is not visualised by Enzyme Linked Immunosorbent Assay