Effectiveness of high‐dose i.v. immunoglobulin therapy for pregnant women with aspirin–heparin‐resistant secondary antiphospholipid syndrome

• Published in: Reproductive medicine and biology 2018-04, Vol.17 (2), p.149-154
• Main Authors: Maesawa, Yoko, Deguchi, Masashi, Tanimura, Kenji, Morizane, Mayumi, Ebina, Yasuhiko, Yamada, Hideto
• Format: Article
• Language: English
• Subjects: Anticoagulants; antiphospholipid antibody; Antiphospholipid syndrome; Aspirin; Care and treatment; Chromosomes; Comparative analysis; Enzymes; Glycoproteins; Health risk assessment; Heparin; immunoglobulin; Immunoglobulins; Karyotypes; Lupus; Miscarriage; Neonates; Original; Preeclampsia; Pregnancy; Pregnant women; Stillbirth; Success; Systemic lupus erythematosus; Womens health
• ISSN: 1445-5781; 1447-0578
• DOI: 10.1002/rmb2.12080

Purpose This study aimed to assess the efficacy of high‐dose i.v. immunoglobulin (HIVIg) therapy in pregnant women with antiphospholipid syndrome (APS) secondary to systemic lupus erythematosus with a history of pregnancy failure, despite receiving low‐dose aspirin plus unfractionated heparin therapy, of which condition being designated as “aspirin–heparin‐resistant APS” (AHRAPS). Methods The HIVIg therapy (20 g/d, 5 days) was performed for the pregnancies of five women with AHRAPS. Results Five of the eight pregnancies ended in live births. The gestational ages of delivery in four of the five pregnancies were extended, compared with previous pregnancies. The HIVIg therapy was considered to be successful for these four pregnancies. Excluding one pregnancy that ended in miscarriage with an abnormal chromosome karyotype of the villi, the HIVIg therapy was considered to be successful in four (57.1%) of the seven pregnancies of the women with AHRAPS. Although all the live newborns were prematurely delivered, no adverse effect of the HIVIg therapy was observed. Conclusions The HIVIg therapy might be beneficial as an immune modifier for pregnant women with AHRAPS. However, the precise indication of which women with AHRAPS who should receive HIVIg therapy remains unknown. High dose intravenous immunoglobulin (HIVIg) therapy (20 g/day, 5 days) was performed in eight pregnancies from five women with antiphospholipid syndrome (APS) who had a history of pregnancy failure despite receiving low dose aspirin plus unfractionated heparin therapy. Five of the eight pregnancies ended in live birth. HIVIg therapy might be beneficial as an immune modifier for pregnant women with APS.