Miscarriage and Its Associations

Stephen Brown, M.D.

Disclosures

Semin Reprod Med. 2008;26(5):391-400. 

In This Article

Acquired Thrombophilia

Antiphospholipid Syndrome

Antiphospholipid antibodies (aPL) are a family of autoantibodies directed against phospholipid-binding plasma proteins, the two most clinically relevant of which are the lupus anticoagulant (LA) and the anticardiolipin antibodies (aCL). There is long-standing and general agreement that the persistent presence of either of these antibodies is associated with an increased risk of second- and third-trimester pregnancy loss,[28] making it important that women with such losses be assessed for their presence. The mechanism postulated is thrombosis of placental vasculature, although pathologic findings are not always consistent with this. Treatment with heparin and aspirin in such women has been shown to have clear benefit.[29,30,31]

Not infrequently, one encounters patients with a history of early (< 10 week) loss and aPL and/or aCL. With respect to early first-trimester loss, there is significant controversy about the role of aPL.[32] Several reports have suggested that aPL are present more often in women with recurrent first-trimester loss than in controls, whereas others have shown that this is not the case.[33,34] A recent meta-analysis has shown that aPL and aCL are associated with "early" (less than 19 week) loss,[35a] but the individual studies that the result is based on do not allow an assessment of first- versus second-trimester loss. A recent Cochrane review concludes that treatment with heparin and aspirin can reduce pregnancy loss by 54%.[35b] However, this result is based largely on the two studies cited above and does not allow strong conclusions about women with losses at less than 14 weeks. Given that women with recurrent losses, even at early gestational ages, are understandably desperate, it seems reasonable to test for the presence of aPL and aCL and to treat those women with persistent antibodies. However, further studies of the role of acquired thrombophilia in early pregnancy loss are clearly needed.

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