Abstract
OBJECTIVE: To characterize patients with non-criteria obstetric antiphospholipid syndrome (NOAPS) and to evaluate how distinct antiphospholipid antibody (aPL) profiles relate to adverse gestational outcomes. METHODS: We retrospectively analyzed 350 women diagnosed from November 2021 to July 2024. Collected information included demographic characteristics, aPL stratification, anticardiolipin antibodies (ACA), anti-β2 glycoprotein I antibodies (aβ2-GPIs), lupus anticoagulant (LA), treatment regimens, therapy duration, and obstetric outcomes (such as recurrent miscarriage, hypertensive disorders, premature delivery, and intrauterine growth restriction). Participants were grouped into high-, medium-, and low-risk categories according to aPL stratification. Propensity score matching (PSM) was conducted in R software, and maternal-fetal outcomes were compared across the three strata. Logistic regression was applied to assess the impact of aPL profiles, and correlation analyses plus heatmaps were used to visualize associations. RESULTS: Recurrent miscarriage was most frequent in high-risk women (50.56% vs. 13.48% in low-risk, P < 0.001). The incidence of preeclampsia was 38.20% in the high-risk group compared with 16.85% and 20.23% in the medium- and low-risk groups (P = 0.002). Preterm birth (26.97%) and fetal growth restriction (23.60%) were also significantly more common in the high-risk cohort (both P < 0.01). Fetal distress occurred in 49.44% of high-risk patients, exceeding rates in the medium-risk (32.58%) and low-risk (15.73%) groups (both P < 0.01). Multivariable regression indicated that high-risk profiles were strongly linked to poor maternal and neonatal outcomes (Maternal: OR = 5.013, 95% CI 2.683-9.613; Neonatal: OR = 12.302, 95% CI 6.092-26.283). aPL stratification independently predicted placental abruption, miscarriage, preeclampsia, premature birth, growth restriction, and fetal distress (OR = 1.470-6.938). LA was identified as a predictor of maternal venous thrombosis (OR = 17.556, 95% CI 1.541-200.068), while ACA contributed to preeclampsia risk (OR = 1.778, 95% CI 1.283-2.465). Elevated ACA titers and positive aβ2-GPI results were significant for fetal distress (OR = 1.040 and 1.881). CONCLUSION: In NOAPS patients, risk stratification based on aPL antibody types, titers, and combination patterns can effectively predict adverse maternal-neonatal pregnancy outcomes. High-risk patients often need prompt, intensive anticoagulant therapy together with coordinated multidisciplinary surveillance.