Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy.
BACKGROUND
Although women with antiphospholipid antibodies (APLAs) are at increased risk of recurrent miscarriage, the outcome of a subsequent pregnancy is not clearly elucidated.


OBJECTIVE
To assess the pregnancy outcome of a subsequent pregnancy in women with APLAs and compare this outcome with women with unexplained recurrent miscarriage.


METHODS
We performed a cohort study among all women who attended the Miscarriage Clinic at Liverpool Women's Hospital between 1987 and 2006 after being referred due to recurrent miscarriage (≥2 consecutive pregnancy losses). All women underwent a standardized investigation sequence. Women with other reasons for recurrent miscarriage were excluded.


RESULTS
A total of 693 women fulfilled the selection criteria, of whom 176 (25%) had APLAs. One hundred and twenty-two (69%) women with APLAs had a subsequent live birth compared with 324 (63%) women with unexplained recurrent miscarriage (OR 1.3, 95% CI 0.9-1.9). No differences were found for birth weight, gestational age, and intra-uterine growth restriction. When treatment was analyzed, 53/67 (79%) of women with APLAs who had received aspirin and heparin during their pregnancy had a live birth, compared with 64/104 (62%) of women with APLAs who received aspirin only (adjusted OR 2.7, 95% CI 1.3-5.8). In unexplained recurrent miscarriage, stratification for treatment showed no differences in outcome.


CONCLUSIONS
The prognosis of a subsequent pregnancy in women with APLAs is good. Although this was not a randomized clinical trial, combined treatment of aspirin and heparin seemed associated with a better outcome in women with APLAs, but not in women with unexplained recurrent miscarriage.
Cohn
D M
DM
Department of Internal Medicine, Academic Medical Center Center, University of Amsterdam, the Netherlands. d.m.cohn@amc.uva.nl
Goddijn
M
M
Middeldorp
S
S
Korevaar
J C
JC
Dawood
F
F
Farquharson
R G
RG
D000026:Abortion, Habitual / Q000276:immunology* / Q000517:prevention & control*; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011379:Prognosis
D000894:Anti-Inflammatory Agents, Non-Steroidal; D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D006493:Heparin; D001241:Aspirin