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Objective To determine prevalence, clinical association and predictive power of antiphospholipid antibodies in pregnancy. Design To test for the presence of anticardiolipin antibodies and lupus anticoagulant in order to confirm prevalence data which imply that each antibody has the same clinical significance. A detailed obstetric history and the outcome measures were obtained from each patient in the study. Setting National Women's Hospital, Auckland, New Zealand. Subjects Nine hundred and thirty‐three consecutively booked pregnant women. Main outcome measures Prevalence of auto‐antibodies; perinatal morbidity and mortality; incidence of preeclampsia, growth retardation and fetal distress. Results Nine women (1.0%) had anticardiolipin antibodies, 11 (1.2%) had lupus anticoagulant and two had both antibodies. The fetal mortality rate for women with antibodies was 167/1000. Pre‐eclampsia occurred significantly more often in women with auto‐antibodies. Conclusion The presence of antiphospholipid antibodies is frequently associated with adverse pregnancy outcome (9/18 pregnancies). High titre anticardiolipin antibodies carry a poor prognosis.

summary In a group of 10 women with circulating lupus anticoagulant 25 intrauterine deaths were previously documented in the nine multigravidae. The presence of lupus anticoagulant activity was confirmed by showing prolongation of the activated partial thromboplastin time and kaolin clotting time with failure of correction of the prolongation on incubation with normal plasma. A clinical diagnosis of systemic lupus erythematosus (SLE) was made in four women. Three had deep vein thrombosis in pregnancy, one chorea gravidarum while two had only recurrent fetal losses. All the women had positive antinuclear antibody tests and blood platelet counts <175 × 109/1. Anti‐smooth muscle antibody and VDRL tests were each positive in half the patients; anti‐DNA antibody was present in two patients with clinically active SLE. In six pregnancies correction of the activated partial thromboplastin and kaolin clotting time was attempted using prednisone (40–60 mg/day); aspirin, 75 mg/day, was added. Five live infants were obtained, four by spontaneous delivery, when the restoration of the clotting abnormalities to normal was achieved. In one woman presenting with extensive deep vein thrombosis a live infant was delivered following therapeutic doses of heparin and low dose aspirin. Maternal lupus anticoagulant activity has major implications for pregnancy and should be excluded in women with a clinical suspicion of SLE, a positive antinuclear antibody test, thrombotic episodes, biologically false‐positive VDRL and unexplained late or repetitive early fetal losses.

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