Successful treatment of immunologic abortion with low-dose intravenous immunoglobulin

Objective: To evaluate the efficacy of low-dose intravenous immunoglobulin (IVIG) treatment in older women with immunologic abnormalities and recurren t spontaneous abortion (RSA), a condition referred to as immunologic aborti on. Design: Prospective clinical trial. Setting: Outpatient referral practice. Patient(s): Forty-seven women were enrolled in the study. The mean age of t he women was 37 years (range, 28-45 years), and the mean number of prior mi scarriages was 3.7. Immunologic abnormalities included antiphospholipid ant ibodies (32%),antithyroid antibodies (53%), antinuclear antibodies (28%), a ntiovarian antibodies (2%), increased natural killer cells (40%), increased immunoglobulin (Ig)M level (28%), and increased CD4/CD8 T-cell ratio (15%) . One patient had IgA deficiency, and three women had endometriosis. Thirty -one of the 47 patients (66%) had more than one immunologic abnormality. Intervention(s): Treatment with IVIG at a dose of 0.2 g/kg within 2 weeks o f attempted conception. Once conception was achieved, IVIG treatment was co ntinued on a monthly basis at, the same dose through 26-30: weeks of gestat ion. Main Outcome Measure(s): Successful pregnancy or recurrent abortion. Result(s): OF the 47 women, 36 received initial IVIG treatment, and 24 subs equently became pregnant. Of these women, 20 continued IVIG treatment throu gh 26-30 weeks of gestation, and 19 (95%) had a successful term pregnancy. Four women discontinued IVIG therapy after 10-12 weeks of gestation, and 3 (75%) had a successful pregnancy outcome. Of the 11 women who refused IVIG therapy, 7 became pregnant, and all 7 miscarried. The difference in pregnan cy success rate between the IVIG-treated and untreated groups was significa nt (P=.001). Three women had adverse reactions during the low-dose IVIG inf usion, and these reactions resolved when the IVIG brand was changed. Fetal abnormalities were not observed. Conclusion(s): Low-dose IVIG therapy is beneficial for older women with imm unologic abortion. The optimum duration of IVIG treatment in these women re quires further study. (C) 2000 by American Society for Reproductive Medicin e.