Heparin and Pregnancy in Women with a History of Repeated Miscarriages

Abstract

Many patients who experience recurrent spontaneous abortions (RSA) have high titered antibodies to trophoblast antigens and/or negatively charged phospholipids. Pregnancy success has been documented in some of these patients subsequent to heparin treatment. The effect of heparin on in vitro assays used to detect antibodies to phospholipids and trophoblast antigens has been investigated. We have found that complement-mediated detection of antibodies to trophoblast and lymphocyte antigens is inhibited by absorption of sera with solid-phase heparin. The data show that such inhibition involves an inhibitor and a heparin-sensitive regulator of the inhibitor. Heparin inhibits binding of antiphospholipid antibodies to phospholipids in solid-phase ELISA. The mechanism for this inhibition appears to involve an interaction between heparin and antibody to phospholipid. These findings reveal novel heparin-mediated reactions that bridge immunological and hematological interactions. The extent of heparin modulation of these antibody reactivities should be clarified in future clinical trials involving heparin treatment for RSA.

Low dose aspirin and low-molecular-weight heparin in the treatment of pregnant Libyan women with recurrent miscarriage

“…In addition to its anticoagulant action, heparin may act to reduce fetal loss by binding to phospholipids, thereby protecting trophoblast phospholipids from attack and promoting successful implantation in early pregnancy [29]. In our study, there was no difference in pregnancy outcome between the two treatment groups in the pregnancies that survived beyond 13 weeks gestation.…”

Low Dose Aspirin in Combination With Low-Molecular-Weight Heparin Is Better Than Low Dose Aspirin Alone in the Treatment of Pregnant Women With Recurrent Miscarriages

“…28 In addition to its anticoagulant action, heparin may act to reduce fetal loss by binding to phospholipids, thereby protecting trophoblast phospholipids from attack and promoting successful implantation in early pregnancy. 29 In our study, there was no difference in pregnancy outcome between the two treatment groups in the pregnancies that survived beyond 13 weeks gestation. By this time, the first wave of trophoblast invasion is complete and placentation is established.…”

Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies

“…The beneficial role of IVIG has been attributed to its capacity to inhibit aCL and LAC, resulting in an increase in antibody clearance but also to antiidiotype antibody–mediated decreases in aCL production by interaction with B cell antigen receptors (10). Aspirin and heparin may improve pregnancy outcome by blocking platelet cyclooxygenase and thromboxane synthesis (11) and by promoting implantation in early pregnancy and anticoagulation (12), respectively. Low‐dose aspirin also acts as a potent stimulator of interleukin‐3, which has been found to be deficient during APS‐associated miscarriage (13).…”