Antiphospholipid antibodies (APA) and recurrent pregnancy loss: treating a unique APA positive population
Abstract
Background Recurrent pregnancy loss (RPL) has been associated with antiphospholipid antibodies (APA) including anticardiolipin and lupus anticoagulant. Therapy using heparin and aspirin has been shown to significantly improve the live birth rate. We evaluated whether other APA should be considered as a basis for treatment in women with RPL. We also assessed the efficacy of heparin and aspirin therapy compared with aspirin alone in these women. Methods A two-centred, prospective, cohort evaluation of 79 women with two or more consecutive pregnancy losses who underwent a complete evaluation for RPL that was negative except for positive APA. Women with RPL and APA to cardiolipin (CL), phosphatidyl serine (PS) and/or lupus anticoagulant (LAC) treated with heparin and aspirin (group 1) were compared with those with other positive APA (to phosphatidyl inositol, phosphatidyl glycerol and/or phosphatidyl ethanolamine) treated with heparin or aspirin (group 2) or treated with aspirin alone (group 3). Results There were no significant differences in patients' demographics between groups. There were 19 viable infants born to 25 women (76%) in group 1, 18 viable infants born to the 28 women (64%) in group 2, and 12 viable infants born to the 26 women (46%) in group 3. Only the comparison between group 1 and group 3 reached statistical significance (P = 0.03). Conclusion APA other than CL, PS and LAC may be associated with RPL.
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Pooled data from one RCT in women with first-trimester losses and eight observational studies not exclusively early losses indicated higher likelihood of live births with LDA plus prophylactic heparin versus LDA alone.
“Pooled data from one RCT including only patients with a history of first trimester losses46 and eight supporting observational studies47–54 that did not exclusively study women with early pregnancy losses indicated a higher likelihood of live births with combination treatment with LDA and heparin at prophylactic dosage versus LDA alone.”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [53]
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- Authors
- Franklin, R. D., & Kutteh, W. H.
- Affiliations
- University of Tennessee Health Science Center (US)
- ORCID
- Kutteh, W. H.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2002-11-01
- Volume
- 17
- Issue
- 11
- Pages
- 2981-2985
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2170555033
- Cited by
- 92
- References
- 0
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 1 · 2019: 6 · 2018: 4 · 2017: 4 · 2016: 4 · 2015: 6 · 2014: 9 · 2013: 8 · 2012: 4
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- antiphospholipid antibodies, recurrent pregnancy loss, aspirin monotherapy, anticardiolipin antibodies, lupus anticoagulant, phosphatidylserine antibodies, live birth rate, pregnancy outcomes
- MeSH terms
- Abortion, Habitual, Adult, Anticoagulants, Aspirin, Drug Therapy, Combination, Female, Fibrinolytic Agents, Heparin, Humans, Pregnancy, Pregnancy Outcome, Prospective Studies, Cohort Studies, Antibodies, Antiphospholipid
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