Management of Women with Recurrent Pregnancy Losses and Antiphospholipid Antibody Syndrome

Authors

  • Joanne Kwak-Kim,

    Corresponding author
    1. Department of Microbiology and Immunology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
    • Reproductive Medicine, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
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  • Maria Socorro L. Agcaoili,

    1. Reproductive Medicine, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
    2. Allergy, Asthma and Immunology, Department of Internal Medicine, New Sinai MDI Hospital, Laguna, Philippines
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  • Lara Aleta,

    1. Reproductive Medicine, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
    2. Allergy, Asthma, General & Reproductive Immunology, Department of Medicine, University of the Philippines College of Medicine, Manila, Philippines
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  • Aihua Liao,

    1. Reproductive Medicine, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
    2. Family Planning Research Institute, Center for Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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  • Kuniaki Ota,

    1. Reproductive Medicine, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL, USA
    2. Department of Microbiology and Immunology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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  • Svetlana Dambaeva,

    1. Department of Microbiology and Immunology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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  • Kenneth Beaman,

    1. Department of Microbiology and Immunology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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  • Joon Woo Kim,

    1. Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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  • Alice Gilman-Sachs

    1. Department of Microbiology and Immunology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Correspondence

Joanne Kwak-Kim, Department of Obstetrics and Gynecology, The Chicago Medical School at Rosalind Franklin University of Medicine and Science, 830 West End Court, Suite 400, Vernon Hills, IL 60061, USA.

E-mail: joanne.kwakkim@rosalindfranklin.edu

Abstract

Antiphospholipid antibodies (aPL) have been associated with recurrent pregnancy losses (RPL) and other obstetrical complications. The diagnostic criteria for the classical antiphospholipid antibody syndrome (APS) have been utilized for the detection of obstetrical APS in women with RPL. However, laboratory findings and immunopathology of obstetrical APS are significantly different from those of classical APS. In addition, many women with RPL who have positive aPL do not have symptoms consistent with the current APS criteria. The induction of a proinflammatory immune response from trophoblasts and complement activation by aPL rather than thromboembolic changes has been reported as a major immunopathological feature of obstetrical APS. Heparin treatment has been reported to be effective in prevention of early pregnancy loss with APS but not for the late pregnancy loss or complications. The complex effects of heparin may explain the limited efficacy of heparin treatment in RPL. New diagnostic criteria for obstetrical APS are needed urgently, and new therapeutic approaches should be explored further.

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