ACL Antibodies in Pregnancy
After three miscarriages -- believed to be caused by a high level of anti-cardiolipid antibodies -- I am pregnant again. At 10 or 12 weeks I may need to take aspirin daily or receive some kind of daily injections. Please explain the condition and the risks of this experimental therapy?Question:
This is such a confusing topic and an even more confusing condition. We don't know as much as we'd like about it. The clinical picture associated with the presence of ACL antibodies ranges from no symptoms to blood clots, recurrent pregnancy loss, fetal distress, preterm labor, low-birth weight babies and pregnancy-induced hypertension. So, if you have a diagnosis, I hope it is based on sound testing; sometimes, the test for syphilis will be falsely positive (VDRL or RPR). There is a strong correlation between the presence of ACL antibodies and another type of antibody -- lupus anticoagulant. These should be tested for at the same time.
There is no standard protocol for management of this condition. The timing of the start of treatment ranges from before conception, during the first trimester or not until the beginning of the second trimester. The most common regimen is 20 to 60 mg of prednisone plus 80 mg of aspirin (a baby aspirin) daily. These suppress the antibodies and protect the vessels from clots. The regimen is begun as soon as possible after diagnosis, preferably before 12 weeks. Aspirin is given in the same dose throughout pregnancy but the prednisone dosage is decreased when clotting times reach normal. The lowest -- but most effective dose -- of prednisone is desired. These medications are stopped once labor begins.
Some providers prefer the use of Heparin (a blood thinner), especially when the woman is at high risk for fetal loss or a blood clot. This drug is stopped before labor but continued for about a month postpartum. It does not cross the placenta, so fetal effects are rare. It lasts for about 28 hours and, therefore, must be given every day through a Heparin lock affixed into a vein for the duration of the pregnancy.
I would not really categorize this as "experimental." The data are not all in yet, but protocols which improve fetal and maternal outcome are in place.
If you can find a copy of the "Journal of Ob/Gyn Nursing" (JOGNN) Vol 26 (2), March/April, 1997, there is a good article on this condition. I wish you the best.Answer: