Antiphospholipid antibodies (APA) and recurrent pregnancy loss: treating a unique APA positive population

BACKGROUND: Recurrent pregnancy loss (RPL) has been associated with antiphospholipid antibodies (APA) including anticardiolipin and lupus anticoagulant. Therapy using heparin and aspirin has been shown to significantly improve the live birth rate. We evaluated whether other APA should be considered as a basis for treatment in women with RPL. We also assessed the efficacy of heparin and aspirin therapy compared with aspirin alone in these women. METHODS: A two-centred, prospective, cohort evaluation of 79 women with two or more consecutive pregnancy losses who underwent a complete evaluation for RPL that was negative except for positive APA. Women with RPL and APA to cardiolipin (CL), phosphatidyl serine (PS) and/or lupus anticoagulant (LAC) treated with heparin and aspirin (group 1) were compared with those with other positive APA (to phosphatidyl inositol, phosphatidyl glycerol and/or phosphatidyl ethanolamine) treated with heparin or aspirin (group 2) or treated with aspirin alone (group 3). RESULTS: There were no significant differences in patients' demographics between groups. There were 19 viable infants born to 25 women (76%) in group 1, 18 viable infants born to the 28 women (64%) in group 2, and 12 viable infants born to the 26 women (46%) in group 3. Only the comparison between group 1 and group 3 reached statistical significance (P = 0.03). CONCLUSION: APA other than CL, PS and LAC may be associated with RPL.