History Of Previous Pregnancy Loss Research Articles

SARS-CoV-2 infection in pregnant patients on TNFα inhibitor: Real-life data with a review of literature

Tumor necrosis factor alpha (TNFα) is involved in the occurrence of negative pregnancy outcomes. The study aimed to evaluate the safety and efficacy of the immunosuppressive TNFα inhibitors (TNFαi) in the treatment of patients with a history of recurrent reproductive failure in the context of COVID-19 pandemics. We reviewed 85 patients who received TNFαi (certolizumab pegol) during Mainland China’s first wave of COVID-19 pandemic, from 21st Nov 2022–11 th Jan 2023. We also collected corresponding data from 130 pregnant patients who never used TNFαi for comparison. There were no significant differences in the history of previous pregnancy loss, miscarriage, embryo implantation failure, comorbidities and doses of COVID-19 vaccination. 82.2% and 87.7% pregnant patients contracted primary COVID-19 with symptoms in TNFαi group and no-TNFαi group. Duration of symptoms was significantly longer in TNFαi group and the incidences of cough and lethargy was significantly higher in TNFαi group. Both groups reported similar severity to same-aged close contacts, similar rates of other symptoms and hospitalization. No deaths were reported. In the in vitro fertilization (IVF) subgroup, we achieved a biochemical pregnancy loss rate of 17.4%, miscarriage rate of 21.7%, ongoing pregnancy rate and live birth rate of 34.2%. COVID-19 did not influence the live birth rate. We concluded that TNFαi administration in pregnancy was not associated with increased susceptivity to and severity of COVID-19. However, TNFαi users showed more prominent symptoms and longer recovery time. The pregnancy outcomes with TNFαi in such high-risk group for pregnancy loss was satisfactory.

Virtual Prenatal Care: The Effect of Telemedicine and Home-Ultrasound on Maternal Anxiety and Attachment During Pregnancy in Women With a History of Pregnancy Loss [ID: 1375930

INTRODUCTION: We aimed to study the effects of twice-a-week telemedicine visits on maternal anxiety and antenatal attachment in women with a history of previous pregnancy loss by complementing routine prenatal care with home ultrasound. METHODS: This was a randomized controlled trial. Women with history of pregnancy loss (>20 weeks) were recruited and randomized 1:1 in the treatment arms early in their subsequent pregnancy in our high-risk clinic. The control group received routine prenatal high-risk care per protocol, while the study group received additional twice-a-week telemedicine visits with a maternal–fetal medicine specialist, which included a home ultrasound scan (for fetal heart rate, movement, and amniotic fluid) for reassurance. The scan was performed by the patient using a home ultrasound device (Pulsenmore ES) with physician authorization and guidance. Maternal anxiety was evaluated by the validated State-Trait Anxiety Inventory Scale (STAI-S) and maternal attachment was evaluated by the validated Maternal Antenatal Attachment Scale (MAAS-2) at four time points throughout pregnancy. The primary outcome was the STAI-S score at the last prenatal visit. Power analysis required 40 patients to demonstrate a 20% difference in the primary outcome. The study was approved by the local IRB, and all patients signed an informed consent upon randomization. RESULTS: To date, 32 patients completed follow-up, with 16 per arm. There were no differences in demographics or pregnancy outcomes between groups. The study group demonstrated lower anxiety levels at the last prenatal visit (STAI 42.2±4.7 versus 49.6±5.8, P<.001), higher differences between STAI scores at the first versus last visit (−9.9±2.7 versus −7.1±3.1, P=.011), and higher MAAS-2 scores (50.4±3.9 versus 47.2±4.5, P=.039) at last visit. CONCLUSION: Routine prenatal telemedicine visits with home ultrasound can lower maternal anxiety and improve attachment in women with previous pregnancy loss.

Impact of Interleukin-10 Promoter Region Polymorphisms on Recurrent Miscarriage: A Case-Control Approach.

Recurrent miscarriage (RM), defined as two or more consecutive miscarriages prior to the 20th week of gestation is characterised by multifactorial aetiology. The prevalence of RM varies from 0.8% to 13.5% amongst women of reproductive age. The aetiological basis of RM has been traced to chromosomal, anatomic, hormonal and immunologic factors while half of the cases remain idiopathic. This study aimed to investigate the association of interleukin-10 (IL-10) polymorphisms with RM amongst the Indian population. The present study included a total of 414 individuals including RM women (n = 199) with two or more pregnancy losses and healthy women (n = 215) without any previous history of pregnancy loss were taken as the control group. Demographic features and reproductive history of women with RM and healthy women were taken. Genotype analysis of IL-10 polymorphisms rs1800872 and rs1800896 was performed using the polymerase chain reaction (PCR) restriction fragment length polymorphism and amplification mutation refractory system PCR, respectively. Student's t-test was used to compare the demographic features and reproductive history amongst both groups. Pearson's Chi-square was used to calculate the Hardy-Weinberg equilibrium, allelic and genotypic frequencies. All the statistical analyses were performed using the SPSS (version 21, IBM SPSS, NY, USA). Our results suggested that the genotypic and allelic frequency of rs1800872 polymorphism did not differ significantly between RM cases and control women (P = 0.07 and P = 0.23, respectively). The GG genotype (P = 0.007) and G allele (P = 0.003) of rs1800896 were significantly associated with an increased risk of RM. A statistically significant difference was also found for the distribution of genetic models (dominant and co-dominant model) between both groups for rs1800896. However, haplotype analysis revealed that none of the haplotypes provides a risk for the progression of RM. The study is the first of its kind from our region and provides baseline data on the genetics of RM.

EMOTIONAL ASPECTS ASSESSED BY THE DASS-21 SCALE IN PREGNANT WOMEN CONCEIVED BY IN VITRO FERTILIZATION DURING THE COVID-19 PANDEMIC

The COVID-19 pandemic has brought new challenges to infertile couples: the fear and uncertainty of potential SARS-CoV-2 infection effects during pregnancy. The present study aims to evaluate depression, anxiety and stress parameters in pregnant women conceived by IVF, during the coronavirus outbreak. This prospective cohort study included 109 clinical pregnant women (fetal heart beat) that consecutively underwent embryo transfer after an IVF treatment during the coronavirus outbreak between Jun/20 to Feb/21 in a private ART (assisted reproductive technology) clinic. Patients were evaluated through telephonic interview at the end of each trimester of pregnancy (12, 24 and 34 weeks) by the DASS-21 questionnaire, an internationally validated scale to track the severity of depression, anxiety and stress symptoms. Clinical variables such as age, obstetric history, clinical comorbities and years of infertility were also included. Comparison statistical tests were applied accordingly to normal distribution of values. A p value <0,05 was considered significant. The mean age was 38,97±5,02 years old. The majority of patients had never been pregnant before (67%) and had no other comorbid associated (75,2%). The mean infertility time was 3,76±2,38 years. Singleton pregnancies represented 83,5%. During the follow-up, two patients had late miscarriage at 21 weeks of singleton pregnancies (1,8%) and one had a fetal demise at 26 weeks of a singleton pregnancy (0,9%). Four patients (3,7%) had very preterm labor (between 28-32 weeks), seven (6,4%) had moderate preterm labor (between 33-35 weeks) and one (0,9%) had a late preterm labor (36th week). In general, there were no difference in any of the emotional aspects evaluated (depression, anxiety and stress) along first, 2nd and 3rd trimesters (p=0.13, p=0.93 and p=0.55, respectively). However, when participants were separated by groups of age (<38 yo and ≥38 yo, means 34,84±2,90 and 42,35±3,69, p=0.007), older patients presented higher levels of stress (p=0.017) compared to the youngers. Furthermore, patients with history of previous pregnancy loss presented higher levels of anxiety and stress (p=0.037 and 0.036 respectively) compared to the nulliparous. In addition, when comorbidities were associated with infertility, patients also presented higher levels of anxiety and stress (p=0.03 and 0.002, respectively). Years of infertility (≤3 or ˃3 years) was not associated with aggravation in DASS scores during pregnancy. Our data demonstrated that patients who conceived during the pandemic by IVF showed higher levels of anxiety and stress throughout their pregnancy, as assessed by the DASS-21 scale, mainly if they are greater than 38yo, had previous pregnancy loss or presented other comorbity associated.

S977 Ectopic Pregnancy in Women With IBD: Experience at a Tertiary Care IBD Center

Introduction: Women with IBD often have risk factors for ectopic pregnancy (EP) including previous abdominal or pelvic surgery, pelvic sepsis or intra-abdominal adhesions. The prevalence of an ectopic pregnancy among healthy women who present to an emergency department with first trimester bleeding, pain, or both ranges from 6% to 16%. To date, the single large population-based cohort study for EP in IBD was not able to account for medication use, disease activity or severity, and was published prior to wide-spread use of anti-TNF agents in the preconception and pregnancy states. We were interested in assessing EP in our population from a tertiary care IBD center, in particular taking into account disease activity and use of biologics prior to conception. Methods: The electronic medical record was queried for legal sex females with a diagnosis of ulcerative colitis (UC), Crohn's disease (CD) or inflammatory bowel disease (IBD) and a history of a pregnancy event receiving all of their care at our tertiary care center. From this cohort the term “ectopic pregnancy” using ICD-10 code and SNOMED concepts between 1/1/13 and 2/28/2022 were used to identify our population of interest. Chart review including diagnosis, surgical history, current and previous medications, and disease activity at the time of conception was then performed. Pregnancy specific variables include age at time of conception, parity, history of previous pregnancy loss, history of Caesarean section, or endometriosis. Results: 20,624 legal sex females with CD, UC or IBD were identified and 335 patients were diagnosed with a pregnancy event with all of their care at our center. 6 patients were diagnosed with an EP. Of interest, only 4 had their EP after an established diagnosis of UC or CD. Of these 4 patients, 3 had UC and 1 had CD. Duration of disease prior to EP ranged from 6 months to 4 years. Of the 3 patients with UC, all were in remission on either aminosalicylate or anti TNF therapy. The patient with CD had mild activity, was status post one resection and on no medication at the time of the EP. None had other common risk factors for EP. Conclusion: EP in our practice was uncommon, with an incidence of only 2%. Whether this is because of improved control of disease activity or preconception counseling has yet to be determined. Larger population-based studies are needed to assess the impact of newer medical therapies and disease management on the risk of this pregnancy outcome.

History of Pregnancy Loss as a Risk Factor for Myocardial Infarction.

IntroductionThere are few cardiovascular risk factors that are unique to females, such as after menopause, lipid profiles change unfavorably. Another risk factor that might be associated with an increased risk of cardiovascular diseases in women is the incidence of miscarriages and abortions. In this study, we will determine the association between the previous history of pregnancy loss and myocardial infarction (MI).MethodsThis case-control study was conducted from December 2019 to January 2021. We enrolled 600 female patients with a confirmed diagnosis of MI from the outpatient department (OPD) of the cardiology and internal medicine unit of a tertiary care hospital in Pakistan. Another 600 female participants without the diagnosis of MI were enrolled from the OPD as the control group. Participants were asked about the history of pregnancy, including the number of miscarriages, abortions, and stillbirths.ResultsParticipants with myocardial infarction had experienced greater than one miscarriage compared to participants without MI (25.1% vs. 13.6%; p-value: <0.0001). Similarly, participants with MI had significantly more participants with stillbirth compared to participants without MI (12.0% vs. 6.66%; p-value: 0.0017).ConclusionPregnancy loss is associated with MI in the future. Women with a history of pregnancy loss must undergo regular cardiovascular screening to protect themselves from cardiovascular events.

Endometrial osseous metaplasia in a patient with secondary infertility referred for hysterosalpingogram with ultrasound.

Endometrial osseous metaplasia is a rare entity resulting in the formation of trabecular bone fragments within the uterine cavity and frequently presents as secondary infertility with a history of previous pregnancy loss or termination. The unusual transvaginal ultrasound appearances are important to recognise, as fertility is often restored after hysteroscopic removal of the bone fragments from the uterine cavity.

PREGNANCY LOSS IN WOMEN WITH HIV IS NOT ASSOCIATED WITH HIV MARKERS: DATA FROM A NATIONAL STUDY IN ITALY, 2001-2018

BackgroundThere is limited information on pregnancy loss in women with HIV, and it is still debated whether HIV-related markers may play a role.Objectives: To explore potential risk factors for pregnancy loss in women with HIV, with particular reference to modifiable risk factors and markers of HIV disease.MethodsMulticenter observational study of HIV-positive pregnant women. The main outcome measure was pregnancy loss, including both miscarriage (<22 weeks) and stillbirth (≥22 weeks). Possible associations of pregnancy loss were evaluated in univariate and multivariate analyses.ResultsAmong 2696 eligible pregnancies reported between 2001 and 2018, 226 (8.4%) ended in pregnancy loss (miscarriage 198, 7.3%; stillbirth 28, 1.0%). In multivariate analyses, only older age (adjusted odds ratio [AOR] per additional year of age: 1.079, 95% confidence interval [CI] 1.046–1.113), HIV diagnosis before pregnancy (AOR: 2.533, 95%CI 1.407–4.561) and history of pregnancy loss (AOR: 1.625, 95%CI 1.178–2.243) were significantly associated with pregnancy loss. No significant association with pregnancy loss was found for parity, coinfections, sexually transmitted diseases, hypertension, smoking, alcohol and substance use, CD4 cell count, HIV-RNA viral load, and CDC HIV stage.ConclusionsOlder women and those with a previous history of pregnancy loss should be considered at higher risk of pregnancy loss. The severity of HIV disease and potentially modifiable risk factors did not increase the risk of pregnancy loss.

High Prevalence of Sticky Platelet Syndrome in Patients with Infertility and Pregnancy Loss.

Platelet hyperaggregability, known as sticky platelet syndrome (SPS), is a prothrombotic disorder that has been increasingly associated with pregnancy loss. In this retrospective study, we aimed to investigate the clinical and diagnostic relevance of SPS in 208 patients with infertility and unexplained pregnancy loss history. We studied 208 patients that had been referred to undergo a dose-dependent platelet aggregation response to adenosine diphosphate and epinephrine using light transmission aggregometry modified by Mammen during an 11-year period. Patients’ platelet aggregation response was compared with platelet function in 29 female healthy controls of fertile age with no previous history of pregnancy loss. We found a prevalence of SPS type II (33.2%) in 208 female patients with infertility and pregnancy loss. ∆-epinephrine-induced platelet aggregation in patients with SPS was significantly decreased (median 7% and range −21 to 43%) compared to patients without SPS (median 59%, range 7–88% and p < 0.0001) and healthy controls (median 57%, range 8–106% and p < 0.0001). The optimum SPS-diagnostic cutoff value for ∆-epinephrine aggregation was ≤32% (sensitivity 95.7%, specificity 95.2%). SPS patients with low-dose acetylsalicylic acid (ASA) therapy (n = 56) showed improved pregnancy outcome (32 pregnancies; live births n = 18 (56%)) compared to SPS patients without low-dose ASA (n = 13) (3 pregnancies; live births n = 1 (33%)). Our study demonstrates the clinical and diagnostic relevance of platelet hyperaggregation in women with infertility and pregnancy loss history. Further studies should investigate the potential of SPS as a novel decisional tool with both diagnostic and clinical implications in infertility and pregnancy loss.

Role of Human Chorionic Gonadotrophin Compared to 17-Alpha-Hydroxyprogesterone in the Management of Threatened Abortion: Experience in a Military Hospital in Dhaka, Bangladesh

Background: Threatened abortion is the most common complication in the first half of gestation. Spontaneous abortion occurs in less than 30% of the women who experience threatened abortion. In order to prevent pregnancy loss several supportive therapies including hormonal therapy like human chorionic gonadotropin (hCG) or 17-alpha-hydroxyprogesterone (progesterone) have been advocated. The exogenous administration of hCG is aimed at stimulating and therefore optimizing progesterone production. Aim of this study was to compare the efficacy of supportive therapy with hCG and progesterone in women with threatened abortion.&#x0D; Methods: This prospective study was carried out in the department of obstetrics and gynecology of the Combined Military hospital (CMH), Savar, Dhaka, Bangladesh from July 2016 to June 2017. One hundred pregnant patients admitted with the history of per vaginal bleeding before 20 weeks of gestation without having any other co-morbidity were included in this study. Patients were randomized to two treatment groups. The participants in group A (52, 52%) received injection hCG weekly while those in group B (48, 48%) received injection progesterone from recruitment up until 20 weeks of gestation. Further USG were performed one week and four weeks after recruitment to the study and again at 20 weeks and subsequently when indicated. The final outcome of pregnancy were recorded and analyzed.&#x0D; Results: Among 100 patients majority belonged to the 26-30 year age group. Mean age of the patients was 27.2±10.5 years. There was not much significant difference between the groups in terms of parity. More than 75% of patients in both the groups presented before 16 weeks of gestation with threatened abortion. In both the groups more than 75% of the patients had previous history of pregnancy loss. In terms of pregnancy outcome more patients in hCG group had live pregnancy than progesterone group (88.5% vs 66.7%) (p=0.012). Out of 46 live birth in hCG group, 4 (7.7%) were preterm labor between 31-35 weeks of pregnancy and one baby died in neonatal ICU, one died at 31 weeks of gestation which was delivered by vaginally. On the other hand out of 32 live birth in progesterone group, there was 3 (6.3%) preterm labor. Growth retardation was less in hCG group compared to progesterone group (9.6% vs 14.6%). However cesarean section rate was high in both the groups.&#x0D; Conclusion: Treatment with injection hCG has better pregnancy outcome than that of injection17-alphahydroxyprogesterone in early pregnancy with threatened abortion of unexplained cause.&#x0D; Birdem Med J 2019; 9(1): 7-10

Antiplatelet and anticoagulant agents for primary prevention of thrombosis in individuals with antiphospholipid antibodies.

Antiplatelet and anticoagulant agents for primary prevention of thrombosis in individuals with antiphospholipid antibodies.

Association study of CTLA-4 +49A/G gene polymorphism with recurrent pregnancy loss in the Iranian Azeri Turkish ethnic group.

Recurrent pregnancy loss (RPL) is defined as two or more pregnancy losses. T-regulatory cells play an important role in the feto-maternal interface. Cytotoxic-T-lymphocyte antigen-4 (CTLA-4) is a molecule that downregulates the activation and proliferation of T cells. The objective of the current study was to investigate the possible association of CTLA-4+49A/G gene polymorphism with RPL among patients from the Iranian Azeri Turkish ethnic group. The study group/patients consisted of 101 women with the experience of two or more pregnancy losses and the control group consisted of 101 women with at least two live births, without any previous history of pregnancy loss and autoimmune diseases from the same ethnic group. The CTLA-4+49A/G was detected by polymerase chain reaction-restriction fragment length polymorphisms assay. The distribution of CTLA-4+49A/G genotype was AA, 38.61%; AG, 51.48%; GG, 9.9% in patients and AA, 37.62%; AG, 47.52%; GG,14.85% in controls (P-value: 0.2). Furthermore, no association in G-allele was observed in the patient and control groups (P-value: 0.5). The results of the present study suggest that CTLA-4 does not have any association with RPL in the Iranian Azeri Turkish ethnic group.

Inter-Pregnancy Intervals and the Risk of Autism Spectrum Disorder: Results of a Population-Based Study.

Recent studies have reported an increased risk of autism among second-born children conceived <12 versus >36months after the birth of a sibling. Confirmation of this finding would point to inter-pregnancy interval (IPI) as a potentially modifiable risk factor for autism. This study evaluated the relationship between IPI and autism spectrum disorder (ASD) risk in a Wisconsin birth cohort of 31,467second-born children, of whom 160 resided in the study area and were found to have ASD at age 8years. In adjusted analyses, both short (<12) and long (>84month) IPIs were associated with a two-fold risk of ASD relative to IPIs of 24-47months (p<0.05). The long IPI association was partially confounded by history of previous pregnancy loss.

English

BACKGROUND: Gestational diabetes mellitus (GDM) is a disorder of carbohydrate metabolism with grave consequences for both the mother and child. Numerous methodologies for the diagnosis of GDM have been proposed. We used the Diabetes in pregnancy study group India (DIPSI) procedure to diagnose GDM. The objectives of this study are to find out the incidence of gestational diabetes mellitus in pregnant women and their pregnancy outcomes in a rural setting. MATERIALS AND METHODS: It is a hospital based prospective study performed on 400 pregnant women between 24 to 28 weeks of gestation over a period of one year. All were given a 75 gms oral glucose load, irrespective of their last meal, and venous plasma glucose was estimated after 2 hours. Cases with 2 hours plasma glucose value ≥140 mg% were diagnosed as GDM. All GDM patients were followed up and treated with medical nutrition therapy (MNT) and/or insulin therapy till delivery to know the maternal and foetal outcomes. RESULTS: The incidence of GDM was 5.7 % using the DIPSI method. GDM was observed more frequently in age ≥25years (34.8%), BMI ≥25 (39.1%), past history of GDM (4.3%), family history (13%), history of previous pregnancy loss (13.8%), and history of polyhydramnios (8.7%). The foetal and maternal outcomes in GDM were: anencephaly (4.3%), gestational hypertension (8.7%), macrosomia (13.0%) and preterm delivery (17.4%). CONCLUSION: Women with GDM are at an increased risk for adverse obstetric and perinatal outcome. Screening the pregnant women for GDM and achieving euglycemia can prevent maternal and foetal complications. Hence, universal instead of selective screening should be mandatory. DIPSI procedure is a one step cost effective procedure for

Disfunción tiroidea en las pacientes abortadoras. ¿Existen argumentos para el cribado?

Objectives Normal thyroid function is crucial for adequate maternal and fetal development in pregnancy. There is solid evidence of the pernicious effects of thyroid dysfunction in pregnancy for both mother and fetus. One of these effects is miscarriage and recurrent pregnancy losses. Nevertheless, there is no general agreement on the advisability of screening for thyroid dysfunction in pregnant women, even when there is a previous history of pregnancy loss. This study aimed to determine the prevalence of thyroid dysfunction (including anti-thyroid autoimmunity without abnormal T3/T4/TSH levels) in patients with spontaneous abortion. Subjects and methods T3-T4-TSH-antithyroid antibodies (thyroglobulin and thyroperoxidase) were determined at diagnosis in 132 consecutive women with spontaneous miscarriage. Results Nearly 25% of the patients had undiagnosed and untreated thyroid disturbance. Conclusion The results obtained suggest that the prevalence of thyroid dysfunction in patients with spontaneous miscarriage is higher than previously reported in our environment.

High-risk pregnancy and hypoluteoidism in the bitch

High-risk pregnancies are those in which the prevalence of maternal, fetal and/or perinatal morbidity or mortality is likely to be higher than that of the general obstetrical population. Some maternal characteristics associated with risk to maternal, fetal and/or perinatal health are readily identifiable prior to conception, such as advanced maternal age, brachycephalic breed, or a previous history of pregnancy loss. Others, such as gestational diabetes or a singleton litter, are recognized after conception. Early recognition of the problem (i.e. the risk), anticipation of the potential sequelae, and development of an aggressive management scheme are essential for a successful outcome of a high-risk pregnancy. A previous history of pregnancy loss is a high-risk factor for recurrence during subsequent pregnancies. Infection is a common cause. In some instances, recurrent pregnancy loss is associated with low serum concentrations of progesterone. Although the mechanism(s) by which this occurs is not fully understood, the situation has been called hypoluteoidism. Whatever the cause of the risks to pregnancy, the goals of managing high-risk pregnancies are to optimize maternal, fetal and perinatal health, so as to maintain maternal health throughout pregnancy and lactation and maximize the number of healthy pups surviving to weaning age.

OUTCOME OF IN-VITRO FERTILIZATION AND THE AUTO ANTIBODIES AGAINST ANNEXIN V AND CARDIOLIPIN

Objective: To evaluate the role of anti-annexin V antibodies (aANX) and anticardiolipin antibodies (ACA) as riskfactors and predictors for in vitro fertilization-embryo transfer (IVF or ICSI) outcome.Design: Prospective study,Setting: IVF unit, Int. Islamic center for population studies and researches, Al-Azhar University, and Health centers in10lh of Ramadan city.Subjects and Methods: Were classified into 3 groups:-Group I: 30 women had one or more failed IVFJET despite good morphological quality of the transferred embryos.Group II: 30 non-pregnant women had previous history of live births.Group III: 30 pregnant women in the first trimester as controls previously delivered normally and no previous historyof pregnancy loss. All were submitted to:1) Detailed history to eliminate any case with renal, hepatic, or metabolic diseases.2) Complete medical examination and laboratory investigations to exclude autoimmune disease, infection. hypertension, D.M., or other endocrinal disease.3) a- Serum antiannexin V antibodies were measured by Eliza. b-Serum anticardiolipin antibodies were measured by Eliza.Results:1) Serum antiannexin V IgG and serum anticardiolipin IgG were increased significantly in group I compared to the other groups.2) There was no significant difference between group II&III for both parameters of antiannexin V IgG & anticardiolipin IgG with lower level in group III than group II.Conclusion: The antiannexin V IgG & anticardiolipin IgG both can be used as predictors for IVF-ET success.

Anti-β2-glycoprotein I antibodies are associated with pregnancy loss in women with the lupus anticoagulant

The presence of lupus anticoagulant (LA) predisposes to fetal loss and to venous and arterial thrombosis; however, a subgroup of women is unaffected by pregnancy loss. Currently, no predictive markers are available for the identification of women positive for LA at increased risk for pregnancy loss. It was the aim of our study to investigate whether increased anti-beta2-GPI-antibodies predict pregnancy loss in women positive for LA. We performed a cross-sectional study in a cohort of 39 women with persistent LA, who had in total 111 pregnancies. Fifteen women had exclusively normal pregnancies (30 pregnancies) and 24 women had pregnancy losses (81 pregnancies). Anti-beta2-GPI-antibodies were determined using a semiquantitative enzyme linked immunoassay (QUANTA Lite beta2 GPI IgG and IgM; Inova Diagnostics). Increased levels of anti-beta2-GPI antibodies were significantly associated with pregnancy loss [odds ratio (OR) 9.6, 95% confidence interval (CI) 1.6-56.4]. This risk was even higher in the subgroup of women (n = 16) with more than two miscarriages or fetal loss after the first trimester [OR 13.1, 95% CI 1.4-126.3]. There was no significant association between anticardiolipin antibodies and pregnancy loss [OR 3.5, 95% CI 0.7-17.6]. The co-existence of anti-beta2-GPI and anticardiolipin antibodies was also predictive for pregnancy loss [OR 6.1, 95% CI 1.3-29.7]. Interestingly, the prevalence of thrombosis was similar between women with normal pregnancy (87%) and those with pregnancy loss (75%). We conclude that increased levels of anti-beta2-GPI antibodies are predictive for pregnancy loss among women positive for LA, and that prophylactic treatment should be considered in these women even without a history of previous pregnancy loss.

Sex hormones and pregnancy in rheumatoid arthritis and systemic lupus erythematosus.

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are autoimmune disorders with a preponderance in females. RA and SLE differ in their response to sex hormones. Disease development of RA is mitigated by estrogen and pregnancy whereas SLE tends to flare during pregnancy and in response to estrogen. Pregnancy improves the symptoms of RA in about 75% of pregnant patients, but relapses within six months postpartum in 90% of cases. RA is regarded as a T cell-mediated and TH1 immune response-driven disease. Pregnancy induces a shift from TH1 to TH2 immune response, increasing the anti-inflammatory cytokines IL-4 and IL-10, which may contribute to gestational amelioration of RA. Prospective studies of SLE pregnancies indicate that about 50% of patients experience a flare, however, with no permanent aggravation of the disease. Lupus nephritis, presence of antiphospholipid antibodies, and a previous history of pregnancy loss increase the risk of complications during pregnancy and fetal loss. The marked increase of estrogen and progesterone during pregnancy seems to enhance some of the manifestations of SLE. The shift to a TH2 immune response may trigger SLE manifestations that are dependent on humoral immune responses such as lupus nephritis. Another factor stimulating immune responses is the pituitary hormone prolactin, which has been found elevated in SLE patients of both sexes and correlated to disease activity in several studies. The hyperprolactinemia of lactation seems to influence postpartum behavior of SLE as well as RA.