Obstetric performance in patients with the lupus anticoagulant and/or anticardiolipin antibodies.
Antiphospholipid antibodies, notably the lupus anticoagulant and anticardiolipin antibodies, are associated with recurrent fetal wastage, pregnancy complications, and thromboses. Aggressive medical treatment using aspirin and steroids has been recommended. Fifty-one patients with antiphospholipid antibodies, only four with underlying connective tissue disorders, were followed through 53 pregnancies. Aggressive therapy was used in 33 pregnancies, 90.9% of which resulted in successful obstetric outcomes, a highly statistically significant difference compared with previous pregnancies in the same patients. Most pregnancies among nine patients receiving single-agent therapy (aspirin or steroids alone) and eight patients not treated also had successful outcomes. A 48.6% complication rate was found in association with therapy, particularly gestational diabetes mellitus. There was no statistical correlation between dose or duration of therapy and development of treatment-related complications. Although a subgroup of patients with antiphospholipid antibodies will benefit from aggressive therapy, the high complication rate warrants close observation.
Landy
H J
HJ
Department of Obstetrics and Gynecology, George Washington University Medical Center, Washington, DC.
Kessler
C
C
Kelly
W K
WK
Weingold
A B
AB
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000188:drug therapy / Q000453:epidemiology*; D001241:Aspirin / Q000627:therapeutic use; D002308:Cardiolipins / Q000276:immunology*; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000032:analysis*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*
D000305:Adrenal Cortex Hormones; D002308:Cardiolipins; D016682:Lupus Coagulation Inhibitor; D006493:Heparin; D001241:Aspirin