UTILIZATION OF INTRAVENOUS IMMUNOGLOBULIN THERAPY TO TREAT RECURRENT PREGNANCY LOSS IN THE ANTIPHOSPHOLIPID SYNDROME - A REVIEW

Although experience is still limited, intravenous immunoglobulin thera py for recurrent pregnancy loss in the Antiphospholipid Syndrome (APS) may represent a significant advance. APS was widely recognized only f ifteen years ago. Pregnancy loss and thrombosis are the prominent clin ical features. Initially, prednisone was used for treatment of pregnan cy loss, but matemal and fetal complications stimulated searches for a lternative therapy. Subcutaneous heparin and low dose aspirin was next utilized, but although efficacious, there is still a 30% failure rate , and intrauterine growth retardation, prematurity, and pre-eclampsia are relatively frequent. In the late 1980's, there were a number of ca se reports of successful pregnancy outcomes after treatment with intra venous immunoglobulin (IVIg) but regimens differed. Series from two ce nters have confirmed these initial findings and treatment regimens hav e become more consistent. Both centers have reported success with dose s of 400 mg/kg/day for 5 days or 1 g/kg/day for two days each month in itiated during the first or early second trimester. Success rates of 7 0-100% have been reported, and complications such as pre-eclampsia, in trauterine growth retardation, and premature births appear reduced, wh en compared to prednisone and low dose aspirin or heparin and low dose aspirin. Several patients who were treated with IVIg also received he parin, making it uncertain whether heparin may also need to be added t o IVIg. Intravenous immunoglobulin is safe, but expensive. Despite its expense, if IVIG is shown to markedly decrease matemal and fetal morb idity, it may be the logical treatment of choice to prevent pregnancy loss in APS.