Pregnancy outcome in recurrent miscarriage due to antiphospholipid syndrome: a comparative study of intravenous immunoglobulins versus low-dose aspirin plus low-dose heparin

ABSTRACT

The objective was to compare the use of intravenous immunoglobulins [IVIG] with low-dose aspirin plus low-dose heparin in treating pregnant women with a history of recurrent fetal loss, having the antiphospholipid antibodies [aPLs] due to antiphospholipid syndrome [APS], in terms of live-birth rate and maternal and perinatal morbidity. One hundred women [median age 32 years [range 22-42]] with a history of recurrent miscarriage [median number 4 [range 2-12]] and persistantly positive results for aPLs. When fetal heart activity was seen on ultrasonography, 50 women started on IVIG and 50 women were kept on low-dose aspirin and heparin, until 34 weeks gestation or at the time of miscarriage. There was no significant difference in the two groups in age or the number and gestation of previous miscarriages. The rate of live-births with IVIG therapy was 72% [36/50 pregnancies] and 44% [22/50 pregnancies] with low-dose aspirin and heparin. More than 90% of miscarriages occurred in the first trimester. There was no difference in outcome between the two treatments, in pregnancies that advanced beyond 13 weeks gestation. It is concluded that treatment with IVIG leads to a significantly higher rate of live-births in women with a history of recurrent miscarriage associated with aPLs, due to APS, than that achieved with low-dose aspirin plus low-dose heparin