Recurrent Miscarriage in Women with and without Antiphospholipid Syndrome: Prognosis and Predictors of a Subsequent Successful Delivery.

Women with antiphospholipid syndrome (APS) are at increased risk of recurrent miscarriage. Remarkably, the outcome of a successive pregnancy in women with APS and recurrent miscarriage is merely unknown.

We performed a cohort study including all women with 2 or more consecutive miscarriages who attended the recurrent miscarriage clinic of Liverpool Women's Hospital, Liverpool, UK between 1988 and 2006. All women underwent a systematic diagnostic work up including testing for APS. Women with proven APS (according to the SAPPORO criteria) were studied, and outcomes were compared to women with unexplained recurrent miscarriage. We excluded all women from couples with other reasons for recurrent miscarriage.

737 women were included, of whom 220 (30%) had APS. Mean age (32 years) and obstetric history (mean number of prior losses: 3) did not differ between women with and without APS. Of women with APS, 148 (67%) had a successful pregnancy outcome as compared to 324 women without APS (63%), OR=1.2 (95%CI 0.9 to 1.7). No differences were found for birth weight, gestational age, and intra-uterine growth retardation. Women with APS who received aspirin and heparin more often had a successful pregnancy 53/67 (79%) as compared to women without treatment 26/44 (59%); OR=2.6 (95%CI 1.0 to 6.6). Combined use of aspirin and heparin was not associated with an increased success rate in women without APS: 25/43 (58%) vs 204/305 (67%); OR=0.7 (95%CI 0.3-1.4).

The prognosis of a successive pregnancy in women with recurrent miscarriage and APS was comparable to women with unexplained recurrent miscarriage. However, the combined use of heparin and aspirin was associated with a significantly increased chance of a successful pregnancy in women with APS.

No relevant conflicts of interest to declare.