Utilization of intravenous immunoglobulin therapy to treat recurrent pregnancy loss in the antiphospholipid syndrome: a review

Abstract

Although experience is still limited, intravenous immunoglobulin therapy for recurrent pregnancy loss in the Antiphospholipid Syndrome (APS) may represent a significant advance. APS was widely recognized only fifteen years ago. Pregnancy loss and thrombosis are the prominent clinical features. Initially, prednisone was used for treatment of pregnancy loss, but maternal and fetal complications stimulated searches for alternative therapy. Subcutaneous heparin and low dose aspirin was next utilized, but although efficacious, there is still a 30% failure rate, and intrauterine growth retardation, prematurity, and pre-eclampsia are relatively frequent. In the late 1980's, there were a number of case reports of successful pregnancy outcomes after treatment with intravenous immunoglobulin (IVIg) but regimens differed. Series from two centers have confirmed these initial findings and treatment regimens have become more consistent. Both centers have reported success with doses of 400 mg/kg/day for 5 days or 1 g/kg/day for two days each month initiated during the first or early second trimester. Success rates of 70–100% have been reported, and complications such as pre-eclampsia, intrauterine growth retardation, and premature births appear reduced, when compared to prednisone and low dose aspirin or heparin and low dose aspirin. Several patients who were treated with IVIg also received heparin, making it uncertain whether heparin may also need to be added to IVIg. Intravenous immunoglobulin is safe, but expensive. Despite its expense, if IVIG is shown to markedly decrease maternal and fetal morbidity, it may be the logical treatment of choice to prevent pregnancy loss in APS.