Pregnancy complicated by the antiphospholipid syndrome: Outcomes with intravenous immunoglobulin therapy

Objective: To assess maternal and fetal outcomes in 15 patients with antiph ospholipid syndrome (19 pregnancies) treated with intravenous immunoglobuli n (IV Ig) during pregnancy. Methods: Monthly IV Ig therapy was initiated in the first or early second t rimester of all pregnancies except two. Additional therapy consisted of low -dose aspirin and subcutaneous heparin. Six patients also received steroid therapy. Serial anticardiolipin IgG levels were measured in eight pregnanci es. Results: The live-birth rate was 84% (16 of 19 live births), and there were three pregnancy losses. There were no cases of fetal growth restriction (F GR). Preeclampsia and nonreassuring fetal status were each diagnosed in 25% of the pregnancies. Seventy-five percent of the infants were delivered at 34 weeks' gestation or later. Anticardiolipin IgG decreased throughout the course of therapy in seven pregnancies. Placental pathology was minimal. Conclusion: Pregnancy complications appear to be minimized with the use of IV Ig. Definitive recommendations regarding the use of IV Ig in pregnancy a wait the conclusion of randomized trials. If the combination of IV Ig, aspi rin, and heparin significantly decreases the incidences of FGR and prematur ity, it may be a cost-effective primary therapy for pregnancies complicated by the antiphospholipid syndrome. (C) 1999 by The American College of Obst etricians and Gynecologists.