Lupus anticoagulant. Significance in habitual first-trimester abortion

Area of Science:

• Reproductive Medicine
• Immunology
• Obstetrics

Background:

• Recurrent first-trimester abortion is a concern in patients with lupus anticoagulant (LA).
• Previous reports suggested potential benefits of steroid and aspirin therapy for LA pregnancies.

Purpose of the Study:

• To evaluate the efficacy of steroid and aspirin therapy in preventing first-trimester abortions in patients with LA.
• To assess the impact of this treatment on second and third-trimester pregnancy outcomes in LA patients.

Main Methods:

• A comparative study of habitual aborters with LA treated with steroids and aspirin versus an untreated control group of habitual aborters without LA.
• Pregnancy outcomes, including reaching the second trimester, fetal growth, fetal demise, and live birth rates, were compared between groups.

Main Results:

• No significant difference in reaching the second trimester was observed between treated LA patients (50%) and the control group (36%).
• In treated LA patients, 50% experienced fetal growth retardation, and 42% had fetal demise in the second or third trimesters.
• Live birth rates were 29% in treated LA patients and 36% in controls, with the control rate achieved without early intervention.

Conclusions:

• Lupus anticoagulant is unlikely to be the primary cause of first-trimester abortion.
• Steroid and anti-platelet therapy may be necessary for LA patients to mitigate risks of fetal growth retardation and demise in later pregnancy stages, despite associated risks.
• Early intervention with steroids and aspirin may not be beneficial for preventing first-trimester abortions in LA patients.