Pregnancy Outcome in Women with Antiphospholipid Antibodies: Report on a Retrospective Study

Abstract

Antiphospholipid syndrome (APS) represents a serious risk factor in pregnancy resulting in several complications, leading to fetal loss and hemostatic complications. In this dedicated report, we describe our experiences in the treatment of pregnancies in patients with APS. The retrospective data from 140 pregnant women were investigated, and the treatment results of 121 patients were recorded. We studied two groups of patients receiving different treatment. The first group (n ¼ 78) received the standard therapy with low-weight-molecular heparin (dalteparin 5000 U or certoparin 3000 U daily) and aspirin (100 mg daily) and in the second group (n ¼ 43) an additional 0.2 g/kg intravenous immunoglobulin (IVIG). Outcomes were 74.3% and 83.7% live births in the first group and in the second group, respectively. The abortion rate was similar in both groups (11.5% vs. 11.6%). The late complication rate was lower in the second group (5.8% vs. 14.1%, p < 0.05) than in the group with standard therapy. Interestingly, we found a trend to higher percentage (> 12%) of natural killer (NK) cells in patients with pregnancy complications (60% vs. 12%, p < 0.05). Our retrospective data shows an improvement of late pregnancy complications by additional use of IVIG. It is possible that IVIG influences higher NK cell activity in patients with previous pregnancy complications.

Antiphospholipid Syndrome and Pre-Eclampsia

“…This is in accordance with the results of Mello et al 41 47 Lee et al, 50 and Lynch et al 51 found no increased levels of APL but used only different APAs or did not determine anti-b2GP1 51 or LA. The study of Lee et al 52 did not include the test for LA.…”

“…29 In a retrospective study we observed a development of P-EC of 11.5% and 2.3% after treatment with LMWH/ASA or LMWH/ASA/ IVIG in refractory cases, respectively. 52 The problem in most studies is patient selection, the antibody assay techniques, and the major changes of titers. 53,54 We can conclude that women with APAs are at risk for P-EC at <34 weeks of gestation and the HELLP syndrome.…”

Antiphospholipid antibodies in acute cardiac attacks

“…The high level-positive figure of ACA seemed to be seen in older patients with atherosclerosis and rheumatic disorders (Asherson et al, 2001). A prospective study revealed that raised levels of ACA at 40 years of age correlated positively with the incidence of AP and MI, and mortality related to MI 10 to 20 years later (Heilmann et al, 2008). More than 20% of young (< 45 years) survivors of acute MI carry ACA and in those surviving, 61% of the patients with persistent antibodies experienced later another thromboembolic episode (Carl et al, 2008).…”

How to use… lupus anticoagulants: Table 1

“…Fetal loss can occur in up to 15%–20% of pregnancies with maternal aPL antibodies 14 15. It usually occurs after 10 weeks’ gestation in the late first or early second trimester, and may be secondary to thrombosis in the uteroplacental circulation.…”