ANTIPHOSPHOLIPID ANTIBODIES OTHER THAN LUPUS ANTICOAGULANT AND ANTICARDIOLIPIN ANTIBODIES IN WOMEN WITH RECURRENT PREGNANCY LOSS, FERTILE CONTROLS, AND ANTIPHOSPHOLIPID SYNDROME

Objective: To determine whether antiphospholipid antibodies other than lupus anticoagulant and anticardiolipin are associated with recurrent pregnancy loss.Methods: Sera from three groups of women were studied: 1) 147 women with recurrent pregnancy loss but no clinical signs or s ymptoms of autoimmune disease who tested negative for lupus anticoagul ant and medium-to-high levels of immunoglobulin G anticardiolipin anti bodies; 2) 104 healthy, fertile controls of similar age and gravidity; and 3) 43 women with well-characterized antiphospholipid syndrome. Se rum antibody binding against six phospholipids (cardiolipin, phosphati dic acid, phosphatidylserine, phosphatidylcholine, phosphatidylethanol amine, and phosphatidylinositol) was determined using enzyme-linked im munoassays, and results were normalized using an anticardiolipin stand ard. Results: Twenty-six (18%) women with recurrent pregnancy loss and nine (9%) controls tested positive (above the 99th percentile) for an tiphospholipid antibodies. Sera from five (3.4%) women with recurrent pregnancy loss and four (3.8%) controls demonstrated binding to phosph olipid antigens other than cardiolipin. In contrast, binding to phosph olipid antigens was demonstrated in sera from more than 90% of women w ith antiphospholipid syndrome. Among women testing positive for antiph ospholipid antibodies, the median positive value for women in the anti phospholipid syndrome group was significantly higher than for those wi th recurrent pregnancy loss or normal fertile controls. Conclusions: W omen with recurrent pregnancy loss are no more likely than fertile con trols to have elevated levels of antiphospholipid antibodies once lupu s anticoagulant, anticardiolipin, and an obvious clinical history of a utoimmune disease have been excluded. Testing for antiphospholipid ant ibodies other than lupus anticoagulant and anticardiolipin is not clin ically useful in the evaluation of recurrent pregnancy loss. (C) 1997 by The American College of Obstetricians and Gynecologists.