PREGNANCY OUTCOME IN WOMEN WITH ANTIPHOSPHOLIPID ANTIBODIES

The association of antiphospholipid antibodies (APA) or lupus anti-coa gulant (LA) and recurrent fetal loss (RFL) is well established; howeve r, the spectrum of pregnancy outcome in relation to various therapeuti c approaches versus placebo is unknown. We studied 49 women with RFL, 14 with immune thrombocytopenia (ITP) 13 of whom without a history of RFL, and 32 controls (all in the first trimester of pregnancy) for the presence of APA. Tests for APA were positive in 15/49 women with RFL (30%), 6/14 ITP (43%) and 2/32 controls (6%). Treatment in the APA pos itive patients consisted of: no treatment for the 8 patients who had n o history of RFL (Group A; all 34 previous pregnancies successful), as pirin alone (Group B, 5 patients; all 30 previous pregnancies unsucces sful), aspirin with prednisolone (Group C, 9 patients; 69/80 previous pregnancies unsuccessful), or aspirin, prednisolone and immunoglobulin G for resistant cases (Group D, 4 patients, previously in Group C). 1 0/11 (90.9%), 3/7 (43%), 7/13 (53.8%) and 4/7 (57.1%) pregnancies were successful in Group A, B, C and D, respectively. There was a total of 19/45 (42%) failures including 3 pregnancies in one patient who faile d to respond to all forms of therapy. This open study with small subgr oups of patients draws attention to a wide range of pregnancy outcome in women with APA and to the fact that APA may serve only as a marker for a wide range of pathological conditions with variable degrees of d isease severity. More studies are, however, needed to explore the real mechanism of RFL in women with APA and RFL, especially those who are resistant to therapy.