Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy

Abstract

Summary. Background: Although women with antiphospholipid antibodies (APLAs) are at increased risk of recurrent miscarriage, the outcome of a subsequent pregnancy is not clearly elucidated. Objectives: To assess the pregnancy outcome of a subsequent pregnancy in women with APLAs and compare this outcome with women with unexplained recurrent miscarriage. Methods: We performed a cohort study among all women who attended the Miscarriage Clinic at Liverpool WomenÕs Hospital between 1987 and 2006 after being referred due to recurrent miscarriage ( ‡ 2 consecutive pregnancy losses). All women underwent a standardized investigation sequence. Women with other reasons for recurrent miscarriage were excluded. Results: A total of 693 women fulfilled the selection criteria, of whom 176 (25%) had APLAs. One hundred and twenty-two (69%) women with APLAs had a subsequent live birth compared with 324 (63%) women with unexplained recurrent miscarriage (OR 1.3, 95% CI 0.9-1.9). No differences were found for birth weight, gestational age, and intra-uterine growth restriction. When treatment was analyzed, 53/67 (79%) of women with APLAs who had received aspirin and heparin during their pregnancy had a live birth, compared with 64/104 (62%) of women with APLAs who received aspirin only (adjusted OR 2.7, 95% CI 1.3-5.8). In unexplained recurrent miscarriage, stratification for treatment showed no differences in outcome. Conclusion: The prognosis of a subsequent pregnancy in women with APLAs is good. Although this was not a randomized clinical trial, combined treatment of aspirin and heparin seemed associated with a better outcome in women with APLAs, but not in women with unexplained recurrent miscarriage.

Recurrent Spontaneous Miscarriage Is Still a Challenging Diagnostic and Therapeutic Quagmire

“…Some authors quote the age of fetal viability or a gestational age of 24 weeks or less in defining recurrent miscarriage [5], others regard recurrent miscarriage as the loss of 2 or more consecutive pregnancies [11,12]. In this review, RSM is defined as the loss of 3 or more consecutive pregnancies before 20 weeks' gestation, a definition that has been widely adopted [1,2,3,4,6,7,10,13,14]. It is pertinent to state here that in our practice in Kuwait, we do commence RSM investigations in patients 35 years and older who have had 2 or more previous consecutive miscarriages because of the decline in fertility with increasing maternal age.…”

Thrombophilia and Recurrent Pregnancy Loss : Is Heparin Still the Drug of Choice ? = أهبة التخثر و فقدان الحمل المتكرر : هل الهيبارين لايزال العلاج المفضل ؟

“…In Cohn et al 's study (N = 693), only 176 women (25%) were aPL-positive, while the rest had unexplained RPL. 45 Of the aPL-positive women, 69% (n = 122) had a subsequent live birth compared with 63% (n = 324) of the women with unexplained RPL (odds ratio [OR] = 1.3; 95% CI: 0.9-1.9). When the authors analysed the results, they found that 79% of aPL-positive women receiving a combination of heparin and LDA had a live birth compared with 62% of those receiving LDA alone (adjusted OR = 2.7; 95% CI: 1.3-5.8).…”

Maternal Thrombophilia and Adverse Pregnancy Outcome: A Case-Control Study

“…This prothrombotic condition protects against severe hemorrhage during delivery but it may also increase the risk of thrombosis, especially during the first 3 months after delivery. When acquired and/or inherited thrombophilia risk factors are present, they can result in a further imbalance of the prothrombotic process that may increase the risk of thromboembolism, both for venous thromboembolic disease and for adverse pregnancy outcomes [3,4,5]. Pregnancy loss is a relevant public health issue and, despite extensive investigations, a significant proportion of cases remain unexplained [6].…”

“…Pregnancy loss is a relevant public health issue and, despite extensive investigations, a significant proportion of cases remain unexplained [6]. The role of acquired thrombophilia antiphospholipid syndrome as a common and potentially treatable cause of recurrent pregnancy loss is well established [3,4]. Conversely, the role of inherited thrombophilia, reported in many published papers and analyzed in several meta-analyses, is currently not well established [5,7,8,9,10].…”