Anticoagulant Treatment Not While Pregnant

Lupus antibody puts women at risk of pregnancy problems

(RxWiki News) What puts women at risk of pregnancy problems? Lots of factors, including illness, obesity and stress. A recent finding says that a type of antibody is also a risk factor.

Women who have antiphospholipid antibodies (aPLs ), which interfere with blood vessel function, are at risk for pregnancy problems.

Now, a new study led by the Hospital for Special Surgery in New York City reports that a type of aPL called lupus anticoagulant (LAC) is the most important risk factor for pregnancy problems.

Meanwhile, another type of antibody in the same family, which was thought to be a strong risk factor, does not increase risk for pregnancy problems.

"Be aware of your risk for pregnancy complications."

“This study allowed us to identify [groups] of patients with the highest risk [which will allow us] to test new approaches and new drugs,” said senior study author Dr. Jane Salmon, chair of Collette Kean Research and co-director of Mary Kirkland Center for Lupus Research at the Hospital for Special Surgery.

Women who have recurrent pregnancy loss are tested for aPLs, and as many as 15 percent test positive. Doctors often treat aPLs - proteins that may be present in the blood that can increase risk for blood clots or pregnancy loss - with anticoagulants, including expensive heparin injections, which can cause bone loss and bleeding, says the study.

The researchers found that anticoagulant treatment may be unnecessary.

Those who are not at risk for adverse pregnancy outcomes do not need to be treated, said Dr. Michael Lockshin, director of Barbara Volcker Center for Women and Rheumatic Disease and co-director of Mary Kirkland Center for Lupus Research.

Phospholipids, a type of fat in living cells and membranes, create a barrier that allows certain materials to pass in and out of cells. APLs interfere with the function of phospholipids and are at risk for blood clots, stroke and pregnancy complications. Still, some patients with these antibodies can be completely healthy, says the study.

“Phospholipids are highly exposed in the placenta, and as a result [aPLs] concentrate there,” said Salmon.

Doctors from University of Utah Sciences Center and Intermountain Healthcare, New York University School of Medicine and other health centers looked at 144 patients who had aPLs. Of the women, 28 had adverse pregnancy outcomes, which included these conditions: unexplained fetal death after 12 weeks, death after a baby was discharged that was associated with prematurity, premature delivery (occurring before 34 weeks) due to gestational hypertension, maternal hypertension during pregnancy or placental insufficiency, and delivery of a baby that was too small for its gestational age.

The researchers then compared the women with aPLs against 159 healthy pregnant women who were not ill, had never lost a fetus and had no more than one miscarriage, and had at least one successful pregnancy.

The team looked at three different aPLs: lupus anticoagulant [LAC], anticardiolipin antibody [aCL] and antibody to B2 glycoprotein I.

They found that women with LAC were more likely to have pregnancy problems.

The doctors report that 39 percent of women with LAC had an adverse outcome, compared to only 3 percent of women who did not have LAC. Only 8 percent of women with aCL, but not LAC, had an adverse outcome, and other aPLs did not increase risk.

The study is the first published finding of the PROMISSE study, a multicenter, prospective clinical trial examining pregnancy among women with aPL, lupus, both aPL and lupus, and healthy controls. The study includes more than 700 patients from nine centers across North America. The aim of the study is to identify risk factors for pregnancy problems among these women, since about 20-35 percent of patients with lupus and aPL have pregnancy problems.

This study was published in the July issue of the journal Arthritis & Rheumatism. The PROMISSE study is funded by the National Institute of Arthritis, Musculoskeletal and Skin Diseases of the National Institutes of Health. 

Review Date: 
July 5, 2012