Ma. Maclean et al., THE PREVALENCE OF LUPUS ANTICOAGULANT AND ANTICARDIOLIPIN ANTIBODIES IN WOMEN WITH A HISTORY OF FIRST TRIMESTER MISCARRIAGES, British journal of obstetrics and gynaecology, 101(2), 1994, pp. 103-106
Objective To determine the prevalence of lupus anticoagulant and raise
d anticardiolipin antibodies in women with a history of two or more mi
scarriages in the first trimester of pregnancy. Design A prospective s
tudy of lupus anticoagulant and anticardiolipin antibody levels in uns
elected women with a history of two or more first trimester miscarriag
es. Setting The prepregnancy clinic and miscarriage antenatal clinic i
n a tertiary referral centre. Subjects Two hundred and forty-three wom
en, of whom 113 (47%) had a past history of two miscarriages, and 130
(53%) had three or more miscarriages. Main outcome measures Quantitati
ve detection of lupus anticoagulant and anticardiolipin antibodies; nu
mber of miscarriages in women in the normal and the abnormal groups. R
esults Of the 243 women tested, 41 (16.8%) had an abnormality of lupus
anticoagulant or anticardiolipin antibodies. This was significantly d
ifferent from the normal population as previously reported. Sixteen wo
men (6.6%) were positive for lupus anticoagulant, 20 (8.2%) had elevat
ed anticardiolipin antibodies, and five (2%) had both abnormalities. T
he most frequently positive test for lupus anticoagulant was the dilut
e Russel viper venom time, and IgG was the most frequently elevated an
ticardiolipin antibody. Of the women with a history of only two miscar
riages, 15% had an abnormality of lupus anticoagulant or anticardiolip
in antibodies, compared with 185% of those with a history of three or
more miscarriages. This did not reach statistical significance. There
were 117 (48%) primary miscarriers and 126 (52%) secondary miscarriers
. Of the primary miscarriers, 17% had an abnormality, compared to 18%
of the secondary miscarriers. Conclusions These findings provide furth
er evidence of an association between lupus anticoagulant and anticard
iolipin antibodies and early pregnancy loss. It is not known if these
are the cause of miscarriage, markers for miscarriage, or if antiphosp
holipid antibodies develop as a result of a noncontinuing pregnancy. F
urther studies comparing various treatments are required before women
with these antibodies can be optimally managed.