Clark A L, Branch D W, Silver R M, Harris E N, Pierangeli S, Spinnato J A
Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Kentucky 40292, USA.
Obstet Gynecol. 1999 Mar;93(3):437-41. doi: 10.1016/s0029-7844(98)00437-2.
To assess maternal and fetal outcomes in 15 patients with antiphospholipid syndrome (19 pregnancies) treated with intravenous immunoglobulin (IV Ig) during pregnancy.
Monthly IV Ig therapy was initiated in the first or early second trimester of all pregnancies except two. Additional therapy consisted of low-dose aspirin and subcutaneous heparin. Six patients also received steroid therapy. Serial anticardiolipin IgG levels were measured in eight pregnancies.
The live-birth rate was 84% (16 of 19 live births), and there were three pregnancy losses. There were no cases of fetal growth restriction (FGR). Preeclampsia and nonreassuring fetal status were each diagnosed in 25% of the pregnancies. Seventy-five percent of the infants were delivered at 34 weeks' gestation or later. Anticardiolipin IgG decreased throughout the course of therapy in seven pregnancies. Placental pathology was minimal.
Pregnancy complications appear to be minimized with the use of IV Ig. Definitive recommendations regarding the use of IV Ig in pregnancy await the conclusion of randomized trials. If the combination of IV Ig, aspirin, and heparin significantly decreases the incidences of FGR and prematurity, it may be a cost-effective primary therapy for pregnancies complicated by the antiphospholipid syndrome.
评估15例抗磷脂综合征患者（19次妊娠）在孕期接受静脉注射免疫球蛋白（IV Ig）治疗的母婴结局。
除2例妊娠外，所有妊娠均在孕早期或孕中期开始每月进行IV Ig治疗。额外治疗包括低剂量阿司匹林和皮下注射肝素。6例患者还接受了类固醇治疗。对8例妊娠进行了连续抗心磷脂IgG水平检测。
活产率为84%（19次妊娠中有16例活产），3例妊娠丢失。无胎儿生长受限（FGR）病例。子痫前期和胎儿窘迫在25%的妊娠中被诊断。75%的婴儿在妊娠34周或更晚时分娩。7例妊娠在整个治疗过程中抗心磷脂IgG水平下降。胎盘病理改变轻微。
使用IV Ig似乎可将妊娠并发症降至最低。关于孕期使用IV Ig的确切建议有待随机试验得出结论。如果IV Ig、阿司匹林和肝素联合使用能显著降低FGR和早产的发生率，那么它可能是抗磷脂综合征合并妊娠的一种具有成本效益的主要治疗方法。
