RECURRENT ABORTION AND MODERATE OR STRONG ANTIPHOSPHOLIPID ANTIBODY-PRODUCTION

Objective: To investigate the treatment outcome for women suffering re current miscarriages associated with strong or moderate antiphospholip id antibody (aPL) production. Methods: Sixty-seven pregnancies in 61 w omen demonstrating at least one kind of aPL with a history of recurren t miscarriages were treated with: (1) aspirin (ASA) alone; (2) prednis olone (PSL) and ASA; and (3) PSL, ASA, heparin and/or immunoglobulin ( IgG). For comparison purposes the aPL-positive patients were divided i nto two groups, strongly and moderately-positive. IgG and IgM antibodi es against PE and five negatively-charged phospholipids were measured by ELISA between 1987 and 1993. beta(2)-glycoprotein I ( beta(2)GPI) d ependent anticardiolipin antibodies were measured by ELISA since 1993. Lupus anticoagulant was measured by a diluted aPTT method since 1993. Results: Out of a total of 16 (50%) patients strongly-positive for aP L and 47 out of 51 (92.2%) moderately-positive demonstrated a successf ul outcome. The live birth rate moderate group was significantly highe r than in the strongly-positive cases (P < 0.0005). In the cases exhib iting moderate aPL production, 28 out of 30 (93.3%) receiving PSL and ASA and 14 out of 15 (93.3%) treated with ASA alone successfully gave birth. None of the 14 given ASA alone suffered preterm delivery or IUG R. In contrast 12 (36.4%) and 6 (18.2%) of the 33 patients treated wit h the PSL combination therapy suffered from preterm delivery and IUGR, respectively. Conclusions: The live birth rate in patients strongly p ositive for aPL is lower than that in patients with moderate aPL produ ction even if treatment is performed during pregnancy. However, ASA is useful to treat cases with moderate aPL so that distinction of the tw o groups is warranted. (C) 1998 International Federation of Gynecology and Obstetrics.