Heparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies.
Maternal lupus anticoagulants and anticardiolipin antibodies are associated with a syndrome of recurrent pregnancy loss or preterm birth in live-borns, fetal growth retardation, and placental infarction. Fourteen women with one or more abnormal pregnancy outcomes (total 28 losses, one severely growth-retarded premature live-born) and no normal outcomes were treated with full-dose, subcutaneous, twice-daily heparin therapy in subsequent pregnancies. Treatment was started at an estimated gestational age of 10.3 +/- 4.0 (mean +/- SD) weeks (range 6-18), in a mean total daily dosage of 24,700 +/- 7400 units (range 10,000-36,000). Fourteen of 15 pregnancies resulted in live births at 36.1 +/- 1.7 weeks (range 33-39). The mean birth weight percentile was 57 +/- 21 (range 10-90), and Apgar scores were good to excellent. The number of placental infarcts was fewer in treated cases than in previous deliveries. Five fetuses had third-trimester or perinatal problems with no sequelae, four discovered by close maternal-fetal monitoring. There was an increased rate of preterm and cesarean deliveries. Maternal complications of treatment were few and minor, with no hypertension, preeclampsia, or serious drug-related complications. Heparin appears suitable for further investigation in the treatment of this obstetric syndrome.
Rosove
M H
MH
Department of Medicine, University of California, Los Angeles School of Medicine.
Tabsh
K
K
Wasserstrum
N
N
Howard
P
P
Hahn
B H
BH
Kalunian
K C
KC
D000022:Abortion, Spontaneous / Q000209:etiology / Q000276:immunology; D000328:Adult; D001323:Autoantibodies / Q000032:analysis*; D001724:Birth Weight; D001779:Blood Coagulation Factors / Q000032:analysis / Q000276:immunology*; D002308:Cardiolipins / Q000276:immunology*; D005260:Female; D005315:Fetal Diseases / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007238:Infarction / Q000150:complications / Q000276:immunology / Q000517:prevention & control; D016682:Lupus Coagulation Inhibitor; D008180:Lupus Erythematosus, Systemic / Q000276:immunology; D007752:Obstetric Labor, Premature / Q000209:etiology; D010920:Placenta / Q000098:blood supply*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology; D011249:Pregnancy Complications, Cardiovascular / Q000276:immunology / Q000517:prevention & control*; D012008:Recurrence; D012189:Retrospective Studies; D013927:Thrombosis / Q000276:immunology / Q000517:prevention & control
D001323:Autoantibodies; D001779:Blood Coagulation Factors; D002308:Cardiolipins; D016682:Lupus Coagulation Inhibitor; D006493:Heparin