The prognostic value of antinuclear antibodies in women with recurrent pregnancy losses: a prospective controlled study.
Because autoimmune diseases are suspected of causing some cases of recurrent pregnancy loss, we sought clinical and serologic evidence of such diseases in a group of 277 women with recurrent pregnancy loss. Using HEp-2 cells as targets for an indirect immunofluorescence test for antinuclear antibodies, we compared the frequency of a positive antinuclear antibody test in the women with recurrent pregnancy loss to that in 299 pregnant controls and 119 nonpregnant controls. The frequency of positive antinuclear antibody tests at a titer of 1:40 or higher was 16.3% in cases, 16.6% in pregnant controls, and 16.8% in nonpregnant controls. Increasing the critical titer to 1:80, however, led to a statistically significant difference between cases (6.9%) and controls (0 and 0.8%, pregnant and nonpregnant, respectively; P less than .0001). Additional serologic tests failed to identify any subclinical autoimmune diseases, although two antinuclear antibody-negative patients later developed systemic lupus erythematosus. Pregnancy outcome in women with antinuclear antibody titers of 1:80 or higher included 52% live births, compared with 65.6% live births in women with three or more pregnancy losses and an entirely normal comprehensive evaluation, a nonsignificant difference. The combination of clinical evaluation and antinuclear antibody tests did not identify new cases of autoimmune disease in this population.
Department of Obstetrics and Gynecology, University of Pittsburgh School of Medicine, Pennsylvania.
J H
JH
Harger
B S
BS
Rabin
S G
SG
Marchese
D000026:Abortion, Habitual / Q000209:etiology / Q000276:immunology*; D000974:Antibodies, Antinuclear / Q000032:analysis*; D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis; D005260:Female; D005313:Fetal Death; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D011446:Prospective Studies
D000974:Antibodies, Antinuclear