Viewer Question:
I have been diagnosed with the APS Syndrome. I have lost two babies
due to this, one at 31 weeks, and the other at 22 weeks. I had a successful pregnancy outcome between
the two losses, but it was only a miracle. That baby was taken at 34 weeks. My question is this,
only
after my second loss was I diagnosed, so I am now on heparin and baby aspirin, what are the numbers of
success rates with this treatment against the antibodies?
Doctor's Response:
This is an evolving area of medicine. Your current treatment is
up to date. Here is a study of this very subject with the full abstract and statistics:
BMJ 1997 Jan 25;314(7076):253-257
Randomized controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent
miscarriage associated with phospholipid antibodies.
Rai R, Cohen H, Dave M, Regan L
Objective: To determine whether treatment with low dose aspirin
and heparin leads to a higher rate of live births than that achieved
with low dose aspirin alone in women with a history of recurrent
miscarriage associated with phospholipid antibodies (or antiphospholipid
antibodies), lupus anticoagulant, and cardiolipin antibodies (or
anticardiolipin antibodies).
Design: Randomized controlled trial.
Setting: Specialist clinic for recurrent miscarriages. Subjects:
90 women (median age 33 (range 22-43)) with a history of recurrent
miscarriage (median number 4 (range 3-15)) and persistently positive
results for phospholipid antibodies.
Intervention: Either low
dose aspirin (75 mg daily) or low dose aspirin and 5000 U of unfractionated
heparin subcutaneously 12 hourly. All women started treatment
with low dose aspirin when they had a positive urine pregnancy
test. Women were randomly allocated an intervention when fetal
heart activity was seen on ultrasonography. Treatment was stopped
at the time of miscarriage or at 34 weeks' gestation.
Main Outcome
Measures: Rate of live births with the two treatments.
Results:
There was no significant difference in the two groups in age or
the number and gestation of previous miscarriages. The rate of
live births with low dose aspirin and heparin was 71% (32/45 pregnancies)
and 42% (19/45 pregnancies) with low dose aspirin alone (odds
ratio 3.37 (95% confidence interval 1.40 to 8.10)). More than
90% of miscarriages occurred in the first trimester. There was
no difference in outcome between the two treatments in pregnancies
that advanced beyond 13 weeks' gestation. Twelve of the 51 successful
pregnancies (24%) were delivered before 37 weeks' gestation. Women
randomly allocated aspirin and heparin had a median decrease in
lumbar spine bone density of 5.4% (range -8.6% to 1.7%). Conclusion:
Treatment with aspirin and heparin leads to a significantly higher
rate of live births in women with a history of recurrent miscarriage
associated with phospholipid antibodies than that achieved with
aspirin alone.
Best wishes to you and your family and thank you for your question.
Last Editorial Review: 4/1/2002
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