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Recurrent Pregnancy Loss and Antiphospholipid Antibodies
Title: Antiphospholipid antibodies other than lupus anticoagulant and anticardiolipin antibodies in women with recurrent pregnancy loss, fertile controls and antiphospholipid syndrome
Author: D.W. Branch et al.
Address: Salt Lake City, Utah
Source: Obstetrics and Gynecology 89: 549-555,1997 (April)
Summary: This study was to determine whether as a group, antiphospholipid antibodies other than lupus anticoagulant and anticardiolipin are associated with recurrent pregnancy loss. Three groups of women were studied; 1)147 women with repeated pregnancy loss who tested negative for lupus anticoagulant and immunoglobulin G anticardiolipin antibodies, 2) 104 healthy, fertile controls of a similar age and gravidity, 3) 43 women with well characterized antiphospholipid syndrome. Resulting positive tests for antiphospholipid occurred at the following frequency: 3.4% in the recurrent pregnancy loss group, 3.8% in the fertile control group and 90% antiphospholipid syndrome group. The authors conclude that otherwise asymptomatic women should not be tested for other than lupus anticoagulant and anticardiolipin antibodies. They also found no significance in isolated IgM anticardiolipin antibodies or in minimally elevated anticardiolipin antibodies. The authors further suggest in the absence of thrombosis, that the use of heparin in women negative for lupus anticoagulant and anticardiolipin antibodies,is not supported at present.
Comment: It is well established that lupus anticoagulant and anticardiolipin antibodies are associated with recurrent pregnancy loss. These are but 2 of a family of phospholipids that can be isolated and tested. Unfortunately, the assay for cardiolipin antibodies is the only standardized technique. There is debate ranging from, the testing of all infertile and pregnancy loss patients to testing only those with a high probability of the abnormality, that is the mid-trimester hypertensive fetal demise with placental infarcts. It is important that the above authors tended to dismiss IgM as compared to IgG cardiolipin antibodies and low positive IgG titers. Most trials to support the use low dose (325 mg) of aspirin daily. We still need substantiative, "hang your hat on", information about immunologic infertility and pregnancy loss.