Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy

D. M. Cohn, M. Goddijn, S. Middeldorp, J. C. Korevaar, F. Dawood, R. G. Farquharson

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Abstract

Summay Background: Although women with antiphospholipid antibodies (APLAs) are at increased risk of recurrent miscarriage, the outcome of a subsequent pregnancy is not clearly elucidated. Objectives: To assess the pregnancy outcome of a subsequent pregnancy in women with APLAs and compare this outcome to women with unexplained recurrent miscarriage. Methods: We performed a cohort study among all women who attended the Miscarriage Clinic at Liverpool Women's Hospital between 1987 and 2006 referred with recurrent miscarriage (>/=2 consecutive pregnancy losses). All women underwent a standardized investigation sequence. Women with other reasons for recurrent miscarriage were excluded. Results: A total of 693 women fulfilled the selection criteria, of whom 176 (25%) had APLAs. 122 (69%) women with APLAs had a subsequent live birth compared to 324 (63%) women with unexplained recurrent miscarriage (OR 1.3, 95%CI 0.9 to 1.9). No differences were found for birth weight, gestational age, and intra-uterine growth restriction. When treatment was analyzed, 53/67 (79%) of women with APLAs who had received aspirin and heparin during their pregnancy had a live birth, compared to 64/104 (62%) of women with APLAs who received aspirin only (adjusted OR 2.7, 95%CI 1.3 to 5.8). In unexplained recurrent miscarriage, stratification for treatment showed no differences in outcome. Conclusion: The prognosis of a subsequent pregnancy in women with and APLAs is good. Although this was not a randomised clinical trial, combined treatment of aspirin and heparin seemed associated with a better outcome in women with APLAs, but not in women with unexplained recurrent miscarriage
Original languageEnglish
Pages (from-to)2208-2213
JournalJournal of thrombosis and haemostasis
Volume8
Issue number10
DOIs
Publication statusPublished - 2010

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