Pregnancy Outcome in Recurrent Spontaneous Abortion Associated with Antiphospholipid Antibodies: A Comparative Study of Intravenous Immunoglobulin Versus Prednisone Plus Low‐Dose Aspirin

Vaquero, E.; Valensise, H.; Menghini, Simona; Pierro, G. Di; Romaninï, Carlo; Lazzarin, Natalia; Cesa, F

doi:10.1111/j.8755-8920.2001.450309.x

Cited by 90 publications

(35 citation statements)

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“…Intravenous immunoglobulin infusion seems to be effective in some uncontrolled studies, but in randomized studies this very expensive therapy was inferior to LMWH combined with aspirin or unfractionated heparin and aspirin alone (pregnancy loss or premature delivery RR 2.5, 95%-CI 1.27-4.95) [36]. In contrast, outcomes of intravenous immunoglobulin infusion did not significantly differ from that of prednisone and aspirin administration [39]. Although there is only a limited number of randomized studies as yet [40][41][42], LMWH currently replaces unfractionated heparin as drug of choice.…”

Section: Prophylaxis and Therapy During Pregnancymentioning

confidence: 98%

Impact of the Antiphospholipid Syndrome on Complications during Pregnancy

Schleußner¹

2006

Transfus Med Hemother

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The antiphospholipid syndrome (APS) is an autoimmune disease characterized by the appearance of antiphospholipid antibodies (APA) and at least one clinical manifestation like venous and arterial thrombosis or recurrent miscarriages and fetal loss in the second and third trimester. This most common acquired thrombophilia can also cause placental insufficiency, preeclampsia, intrauterine growth retardation, and placental abruption. Several potential pathogenic pathways leading to a procoagulant state by activation of endothelial cells, monocytes or platelets and inhibition of the protein C activation pathway have been identified. These are supposed to be responsible for thrombosis and obstetric complications. Failed trophoblast differentiation and invasiveness, with subsequently hampered uteroplacental development, as well as thrombosis in the placental vessels are further pathogenic pathways for observed complications specific for pregnancy. Tests for anticardiolipin antibodies and lupus anticoagulant are most commonly used in clinical practice although antiphospholipid antibodies are a heterogeneous group. Current criteria for the classification of APS recommend the use of standardized ELISAs that measure ß2- glycoprotein I-dependent IgG and IgM anticardiolipin antibodies and/or lupus anticoagulant. Current recommendations regarding prophylactic and therapeutic strategies in pregnancy are based on a systematic Cochrane review. Although APS is an autoimmune disease, anticoagulant therapy is the favored strategy to prevent thromboembolic events, miscarriages, or other pregnancy complications. The recommended therapy is the combination of heparin and low-dose aspirin reducing pregnancy loss by 54%. Aspirin alone, prednisone, or intravenous immunoglobulin infusion had no significant beneficial effect on pregnancy outcome, but rather a higher rate of side effects. Oral anticoagulants are contraindicated during pregnancy because of substantial embryotoxic side effects. Currently lowmolecular- weight heparin replaces unfractionated heparin as drug of choice because of safe use for mother and fetus as well as fewer side effects as several studies have shown. Our experience has taught us that prophylaxis should be initiated as soon as pregnancy has been recognized in order to prevent the described pathologies in placental development.

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Section: Prophylaxis and Therapy During Pregnancymentioning

confidence: 98%

Impact of the Antiphospholipid Syndrome on Complications during Pregnancy

Schleußner¹

2006

Transfus Med Hemother

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“…Moreover, most experts recommend preconception aspirin because of its possible beneficial effect on early stages of implantation [4,118]. No benefit has been recorded treating pregnant APS women with intravenous immunoglobulins or glucocorticoids [119][120][121][122][123]. A complete aPL profile should be performed in preconception planning but generally should not be repeated during pregnancy.…”

Section: Treatmentmentioning

confidence: 99%

The antiphospholipid syndrome: from pathophysiology to treatment

et al. 2016

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Antiphospholipid antibody syndrome (APS) is an autoimmune acquired thrombophilia characterized by recurrent thrombosis and pregnancy morbidity in the presence of antiphospholipid antibodies (aPL). APS can be primary, if it occurs in the absence of any underlying disease, or secondary, if it is associated with another autoimmune disorder, most commonly systemic lupus erythematosus. The exact pathogenetic mechanism of APS is unknown, but different, not mutually exclusive, models have been proposed to explain how anti-PL autoantibodies might lead to thrombosis and pregnancy morbidity. Diagnosis of APS requires that a patient has both a clinical manifestation (arterial or venous thrombosis and/or pregnancy morbidity) and persistently positive aPL, but the clinical spectrum of the disease encompasses additional manifestations which may affect every organ and cannot be explained exclusively by a prothrombotic state. Treatment for aPL-positive patients is based on the patient's clinical status, presence of an underlying autoimmune disease, and history of thrombotic events. In case of aPL positivity without previous thrombotic events, the treatment is mainly focused on reduction of additional vascular risk factors, while treatment of patients with definite APS is based on long-term anticoagulation. Pregnancy complications are usually managed with low-dose aspirin in association with low molecular weight heparin. Refractory forms of APS could benefit from adding hydroxychloroquine and/or intravenous immunoglobulin to anticoagulation therapy. Promising novel treatments include anti-B cell monoclonal antibodies, new-generation anticoagulants, and complement cascade inhibitors. The objective of this review paper is to summarize the recent literature on APS from pathogenesis to current therapeutic options.

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“…7,[93][94][95][96][97] Recent meta-analysis reported a significant increase in live births following IVIg use in women with secondary recurrent miscarriage although overall live birth rate was not improved. 98 We have reported that IVIg treatment significantly improved reproductive outcome in women with aPL who were refractory to anticoagulation treatment or elevated NK cell levels.…”

Section: The Epitopes Of Apl and Treatment Outcomementioning

confidence: 99%

Management of Women with Recurrent Pregnancy Losses and Antiphospholipid Antibody Syndrome

Kwak‐Kim

Agcaoili

Aleta

et al. 2013

American J Rep Immunol

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Antiphospholipid antibodies (aPL) have been associated with recurrent pregnancy losses (RPL) and other obstetrical complications. The diagnostic criteria for the classical antiphospholipid antibody syndrome (APS) have been utilized for the detection of obstetrical APS in women with RPL. However, laboratory findings and immunopathology of obstetrical APS are significantly different from those of classical APS. In addition, many women with RPL who have positive aPL do not have symptoms consistent with the current APS criteria. The induction of a proinflammatory immune response from trophoblasts and complement activation by aPL rather than thromboembolic changes has been reported as a major immunopathological feature of obstetrical APS. Heparin treatment has been reported to be effective in prevention of early pregnancy loss with APS but not for the late pregnancy loss or complications. The complex effects of heparin may explain the limited efficacy of heparin treatment in RPL. New diagnostic criteria for obstetrical APS are needed urgently, and new therapeutic approaches should be explored further.

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Pregnancy Outcome in Recurrent Spontaneous Abortion Associated with Antiphospholipid Antibodies: A Comparative Study of Intravenous Immunoglobulin Versus Prednisone Plus Low‐Dose Aspirin

Abstract: In patients with aPL syndrome, IVIG treatment improved pregnancy outcome, with significantly lower pregnancy complication rates, when compared with prednisone plus LDA therapy.

Cited by 90 publications

References 0 publications

Impact of the Antiphospholipid Syndrome on Complications during Pregnancy

Impact of the Antiphospholipid Syndrome on Complications during Pregnancy

The antiphospholipid syndrome: from pathophysiology to treatment

Management of Women with Recurrent Pregnancy Losses and Antiphospholipid Antibody Syndrome

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