Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy.
Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
Autoimmun Rev. 2020 Sep;19(9):102620. doi: 10.1016/j.autrev.2020.102620. Epub 2020 Jul 16.
To evaluate the efficacy and safety of intravenous immunoglobulin (IVIg) in secondary prevention of pregnancy complications for patients with obstetric antiphospholipid syndrome (APS) and history of stillbirth.
We described three cases of obstetric APS patients with history of stillbirth treated with IVIg in four pregnancies. In addition, we conducted a systematic literature review on the use of IVIg in obstetric APS with history of stillbirth.
Three patients with obstetric APS and history of stillbirth were treated with prophylactic IVIg, in addition to standard treatment (hydroxychloroquine, low-dose aspirin, low molecular weight heparin, and prednisone), in four pregnancies (three singleton and one twin). All pregnancies resulted in live healthy newborns. Long-term follow-up re-evaluations (24-53 months) did not shown any sign or symptom of active systemic disease, and the children were healthy. The systematic literature review retrieved only three cases of use of IVIg in obstetric APS patients with history of stillbirth. All three cases resulted in live healthy newborns. Only in one case, mild thrombocytopenia occurred during treatment, although this event was unlikely to be related to IVIg.
Our experience suggests that IVIg as secondary prevention of APS-related stillbirth is associated with good pregnancy and long-term outcomes, with no relevant safety concerns. However, the literature evidence on this topic is limited to few isolated cases, and further studies are needed to clarify which obstetric APS patients may benefit the most from IVIg.
评估静脉注射免疫球蛋白（IVIg）在产科抗磷脂综合征（APS）和死胎史患者的妊娠并发症二级预防中的疗效和安全性。
我们描述了 3 例产科 APS 患者，这些患者有死胎史，在 4 次妊娠中接受了 IVIg 治疗。此外，我们对 IVIg 在产科 APS 死胎史患者中的应用进行了系统的文献复习。
3 例产科 APS 患者有死胎史，在标准治疗（羟氯喹、小剂量阿司匹林、低分子肝素和泼尼松）的基础上预防性使用 IVIg，在 4 次妊娠（3 次单胎妊娠和 1 次双胎妊娠）中。所有妊娠均导致活产健康新生儿。长期随访评估（24-53 个月）未发现任何活动性系统性疾病的迹象或症状，且儿童健康。系统文献复习仅检索到 3 例产科 APS 死胎史患者使用 IVIg 的病例。所有 3 例均分娩活产健康新生儿。仅 1 例在治疗过程中出现轻度血小板减少症，但该事件不太可能与 IVIg 有关。
我们的经验表明，IVIg 作为 APS 相关死胎的二级预防与良好的妊娠和长期结局相关，无相关安全性问题。然而，关于这一主题的文献证据仅限于少数孤立的病例，需要进一步研究以阐明哪些产科 APS 患者可能最受益于 IVIg。
