Treatment of pregnant women with recurrent miscarriage associated with phospholipid antibodies

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7104.372 (Published 09 August 1997) Cite this as: BMJ 1997;315:372

General prognosis is favourable in untreated women

  1. Ole B Christiansen, Consultanta
  1. a Department of Obstetrics and Gynaecology, Aalborg Hospital, DK-9100, Aalborg, Denmark
  2. b Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University College London Medical School, London WC1E 6HX
  3. c Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, 75651 Paris Cedex 13, France
  4. d Department of Obstetrics and Gynaecology, Imperial College School of Medicine at St Mary's, London W2 1PG

    Editor—R Rai and colleagues claim that rates of live births are increased in women with recurrent miscarriage who are positive for phospholipid antibodies when they are treated with low dose aspirin alone and are further improved when heparin is added.1 They state that the fetal loss rate is 90% when no treatment is given, and an editorial claims that several non-randomised studies suggest that low dose aspirin is an effective treatment for these women.2

    I disagree with these claims. A series of prospective studies has indicated that the fetal loss rate in untreated women with recurrent miscarriage and cardiolipin antibodies is considerably less than 90%. My group conducted a prospective controlled trial of allogeneic lymphocyte immunisation versus infusion of autologous leucocytes in women with recurrent miscarriage, irrespective of their cardiolipin status.3 All women were tested for cardiolipin antibodies twice: at their first visit (when they were not pregnant) and again as soon as they achieved pregnancy—in almost all cases this was at least two months after the first test. Investigations were done with an enzyme linked immunosorbent assay (ELISA) that fulfils generally accepted recommendations. Cardiolipin values were considered to be raised (>7.0 MPL units or >22.0 GPL units; for definitions see Rai and colleagues' paper) when they exceeded the 95% centile of the measurements in a control group of women of fertile age.

    None of the 71 patients participating in the trial received any treatment with aspirin, heparin, or steroids. Nine patients were positive for either IgM or IgG cardiolipin antibodies both at the first visit and in early pregnancy. Five of these (56% (95% confidence interval 21% to 86%)) miscarried, whereas the four others gave birth to live infants (median birth weight 3010 g). Two of these four women had high titres of cardiolipin antibody in …

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