Obstetric performance in patients with the lupus anticoagulant and/or anticardiolipin antibodies
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H J Landy1, C Kessler, W K Kelly
1Department of Obstetrics and Gynecology, George Washington University Medical Center, Washington, DC.
Insights
Aggressive treatment with aspirin and steroids for antiphospholipid antibodies in pregnancy improved outcomes, but carried a high complication rate. Close monitoring is essential for these patients.
Area of Science:
- Obstetrics and Gynecology
- Immunology
- Rheumatology
Background:
- Antiphospholipid antibodies (aPL) are linked to adverse pregnancy outcomes like fetal loss and thrombosis.
- Current recommendations often include aggressive medical management for aPL-associated pregnancies.
Purpose of the Study:
- To evaluate the efficacy and complication rates of aggressive therapy for pregnancies in patients with antiphospholipid antibodies.
Main Methods:
- A cohort of 51 patients with antiphospholipid antibodies underwent 53 pregnancies.
- Aggressive therapy (aspirin and steroids) was administered in 33 pregnancies.
- Outcomes were compared with previous pregnancies in the same patients and with single-agent or no treatment groups.
Main Results:
- Aggressive therapy resulted in a 90.9% successful obstetric outcome rate, a statistically significant improvement.
- Pregnancies with single-agent therapy or no treatment also showed high success rates.
- A 48.6% complication rate was observed with aggressive therapy, notably gestational diabetes mellitus.
Conclusions:
- While aggressive therapy benefits a subgroup of patients with antiphospholipid antibodies, the significant complication rate necessitates careful patient observation.
- The study highlights a trade-off between improved obstetric outcomes and treatment-related risks.
Abstract:
Antiphospholipid antibodies, notably the lupus anticoagulant and anticardiolipin antibodies, are associated with recurrent fetal wastage, pregnancy complications, and thromboses. Aggressive medical treatment using aspirin and steroids has been recommended. Fifty-one patients with antiphospholipid antibodies, only four with underlying connective tissue disorders, were followed through 53 pregnancies. Aggressive therapy was used in 33 pregnancies, 90.9% of which resulted in successful obstetric outcomes, a highly statistically significant difference compared with previous pregnancies in the same patients. Most pregnancies among nine patients receiving single-agent therapy (aspirin or steroids alone) and eight patients not treated also had successful outcomes. A 48.6% complication rate was found in association with therapy, particularly gestational diabetes mellitus. There was no statistical correlation between dose or duration of therapy and development of treatment-related complications. Although a subgroup of patients with antiphospholipid antibodies will benefit from aggressive therapy, the high complication rate warrants close observation.