Obstetrical outcome of anti-inflammatory and anticoagulation therapy in women with recurrent pregnancy loss or unexplained infertility.

PROBLEM

Women with a history of recurrent pregnancy losses (RPL) and unexplained infertility (UI) have a high incidence of preeclampsia (PE) and other obstetrical complications. We aimed to investigate the incidence of PE and other obstetrical complications in women with RPL or UI who were treated with anti-inflammatory and anticoagulant treatment.

METHODS

The medical records of 72 women who delivered a live born infant from January 2008 to December 2009 with anti-inflammatory (prednisone and/or intravenous immunoglobulin G) and anticoagulant (low-molecular-weight heparin and low-dose aspirin) treatment were reviewed retrospectively. A total of 41 women with a history of RPL and 31 with UI were enrolled as a study group.

RESULTS

All patients had at least one or more positive test results for autoantibodies, thrombophilic gene mutations, elevated proportion of peripheral blood CD56(+) NK cells or NK cell cytotoxicities, or high T helper 1 to T helper 2 cytokine-producing CD3(+) /CD4(+) cell ratios. The incidence of PE was 5.6% (n = 4), which was comparable to that of general population (2009 CDC data) (P > 0.05); one of them developed HELLP syndrome and none exacerbated to eclampsia. Preterm birth was more frequent in study group than general population (21.7 versus 10.4%, P < 0.028); however, early preterm birth (<34 weeks of gestation, 1.72%), small or large for gestation (SGA or LGA) (10.6 and 4.3%, each), gestational diabetes (GDM) (4.2%), and abruptio placentae (0 of 72) were not increased in study group as compared to general population data.

CONCLUSION

The incidences of PE, GDM, SGA, LGA, early preterm birth, and abruptio placentae are not increased in women with RPL or UI who were administered anti-inflammatory and anticoagulation treatment compared to general population. The potential role of anti-inflammatory and anticoagulation treatment in prevention of obstetrical complications in women with immune abnormalities and thrombophilia is suggested.