THE USE OF INTRAVENOUS IMMUNOGLOBULIN IN RECURRENT PREGNANCY LOSS ASSOCIATED WITH COMBINED ALLOIMMUNE AND AUTOIMMUNE ABNORMALITIES

PROBLEM: Several studies have evaluated the effect of intravenous gamm aglobulin (IVIG) in women with unexplained recurrent spontaneous abort ions (RSA). Data regarding the underlying immunologic abnormalities in these patients is scant. This study reports the pregnancy outcome and immunologic changes observed in a large group of women with RSA assoc iated with well-defined alloimmune and autoimmune abnormalities treate d with IVIG. METHODS: Thirty-five patients with three or more recurren t miscarriages were studied. None of the patients had identifiable all oimmune response to paternal lymphocytes. Twenty-four patients had ant i-thyroid antibodies, ten patients had high levels of circulating immu ne complexes, and six patients had anti-cardiolipin antibodies. Five p atients had Hashimoto's disease, one had immune thrombocytopenic purpu ra, and one had Crohn's disease. Twenty-three patients had more than o ne autoimmune abnormality. All patients received IVIG infusions (200-2 50 mg/kg) every 3 weeks during the first 8 months of pregnancy. RESULT S: Twenty-eight patients (80%) had a successful pregnancy. Decrease of the level of autoantibodies and circulating immune complexes was obse rved in all patients who had a successful pregnancy. Only three of the se patients developed measurable alloimmune response to paternal antig ens. CONCLUSIONS: This preliminary study suggests that IVIG may be of benefit to patients with recurrent pregnancy loss associated with comb ined alloimmune and autoimmune abnormalities. This benefit was seen in spite of lack of detectable correction of the alloimmune abnormality in the majority of patients.