In case of recurrent miscarriages, experts like Rheumatologist in Lahore recommend to rule out autoimmune conditions like antiphospholipid antibody syndrome. A high percentage of women suffer with loss of pregnancy secondary to this disorder. Read on to know more about antiphospholipid antibody syndrome, and its role in recurrent miscarriages:
What is antiphospholipid antibody syndrome?
Antiphospholipid antibody syndrome is an autoimmune disorder, in which the body’s own cells attack the phospholipid-bound proteins contained in the blood cells, as well as the, lining of the blood vessels. Consequently, the clotting function of the body—which prevents excessive bleeding—is severely affected. In patients with antiphospholipid antibody syndrome, pregnancy can be threatened because of this, thereby needing close monitoring of the patient.
What is the relation between antiphospholipid antibody syndrome and pregnancy?
Antiphospholipid syndrome is responsible for close to 15 percent of recurrent miscarriage cases. More than half of these instances occurs in the first trimester. The reason for the recurrent miscarriages is hypothesized to be the impeded blood supply to the placenta, which nourishes the fetus. The deprived fetus thereby dies in the uterus, causing miscarriage.
In antiphospholipid antibody syndrome, as mentioned before, the clotting function of the body is upset due to antibodies working against the proteins in blood that bind to phospholipids. Consequently, there is formation of blood clots that can obstruct blood flow to organs. If left untreated, it can result in heart attack, stroke and pulmonary embolism in non-pregnant patients.
In pregnant women, antiphospholipid antibody syndrome can result in interrupted blood supply to the placenta. Researchers believe the high prevalence of early miscarriages in antiphospholipid antibody syndrome patients is due to the blood clots affecting placenta.
Apart from early miscarriages, antiphospholipid antibody syndrome can also result in:
- Late miscarriage
- Placental insufficiency
- Pre-term labor
- Other neonatal complications
What are the symptoms of antiphospholipid antibody syndrome?
Apart from repeated miscarriages, antiphospholipid antibody syndrome presents with:
- Blood clots in the legs
- Transient ischemic attacks (TIAs)
- Cardiovascular diseases with damage to heart valve
- Neurological symptoms like chronic headaches, dementia and seizures
- Low platelet count
How is antiphospholipid antibody syndrome diagnosed?
The diagnosis of antiphospholipid antibody syndrome is based on the presence of one laboratory and one of the clinical criteria.
Clinical criteria include presence of one of the following:
- Three or more unexplained miscarriages
- Vascular thrombosis
- The mother having one premature birth at or before 34 weeks with preeclampsia
- Premature birth with placental insufficiency at or before 34 weeks
- Unexplained death of a normal fetus after 10 weeks of gestation
The lab criteria include:
- Prolonged coagulation on screening tests with phospholipid dependent factors
- Presence of aCL: IgG or IgM immunoglobulin isotype on two or more occasions
- Correction of the coagulation screening test after adding excess phospholipids
- Inability to normalize the screening test with platelet-poor plasma
- Exclusion of other coagulation disorders
The healthcare provider may also investigate for:
- Antiphospholipid tests like checking the levels of beta-2 glycoprotein antibodies
- anticardiolipid antibodies.
What are the treatment options?
Once someone is diagnosed with antiphospholipid antibody syndrome, anticoagulant drugs like warfarin and heparin are the mainstay of treatment. Warfarin interacts dangerously with a number of medications, which is why drugs must only be used after go-ahead from the healthcare provider.
Since there is risk of bleeding with these drugs, the healthcare provider monitors the dosage through regular blood tests. Other drugs that are helpful in treatment include: rituximab, statins and hydroxychloroquine.
For pregnant patients, the treatment regimen planned by experts like Rheumatologist in Islamabad is based on aspirin and low molecular-weight heparin. With these drugs, especially early on in pregnancy, the chances of live birth increase greatly. Unlike non-pregnant patients of antiphospholipid antibody syndrome, warfarin is not used in pregnant women due to risk of birth defects in the baby. Studies show low-molecular weight heparin offers more benefits compared to aspirin alone.