NEW ORLEANS -- Intravenous immunoglobulin therapy may augment heparin and aspirin therapy for patients with antiphospholipid syndrome and recurrent fetal loss, Dr. Mary Stephenson said at the Third International Conference on Sex Hormones, Pregnancy and the Rheumatic Diseases.
Aspirin and heparin treatment can result in a successful pregnancy in 70%-80% of women with antiphospholipid syndrome (APS). Adding intravenous immunoglobulin (IVIG) may allow for successful pregnancy in some of the remaining 20%-30%.
Many of the women who are unable to sustain pregnancies with heparin and aspirin therapy have autoimmune disorders and connective tissue diseases, said Dr. Stephanie Ensworth, who reported the results of a separate study of several of the patients in Dr. Stephenson's study.
Among 14 consecutive patients enrolled from 1998 to 2001 in a prospective study at the British Columbia Women's Hospital and Health Centre, Vancouver, 12 had 23 unsuccessful prior pregnancies while receiving aspirin and heparin therapy, one patient had a heparin allergy, and one had vertebral compression fractures after a successful pregnancy on aspirin and heparin. The 14 patients received aspirin plus IVIG during pregnancy, but their heparin usage varied: 11 were given unfractionated heparin; 1 took the low-molecular-weight heparin, fraxiparine; and 2 did not use heparin.
Of 16 pregnancies, 8 resulted in live births that were delivered between 29 and 40 weeks of gestation. One woman had premature rupture of membranes at 19 weeks' gestation followed by severe oligohydramnios and chorioamnionitis and delivered at 29 weeks. Severe oligohydramnios and intrauterine growth retardation were noted at 18 weeks' gestation in another patient who delivered at 32 weeks' gestation. Of the eight unsuccessful pregnancies, five were miscarriages at less than 10 weeks' gestation, and three were fetal losses, said Dr. Stephenson of the University of British Columbia, Vancouver.
Dr. Ensworth, also of the university, found a high incidence of autoimmune disorders among women who had unsuccessful pregnancies despite treatment with aspirin and heparin. Antinuclear antibodies (ANAs) were detected in 10 of the 12 patients.
One patient had a profile suggestive of autoimmune liver disease, with ANA titers exceeding 1:1,280, a high anti-Ro antibody titer, a low level of C4 complement, a polyclonal increase in [gamma]-globulins, a low-positive titer of anti-smooth muscle antibodies, and an increased level of liver transaminases. She had xerophthalmia, arthralgias, and Raynaud's phenomenon, and was diagnosed with an undifferentiated connective tissue disorder, Dr. Ensworth said at the conference, sponsored by the University of Connecticut and the University of Utah.
COPYRIGHT 2003 International Medical News Group
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