Antiphospholipid antibodies and lipoprotein (a) in women with recurrent fetal loss.

Objective: To estimate the occurrence of lupus anticoagulant, both isotypes of anticardiolipins, IgG and IgM, and lipoprotein (a) in women with recurrent fetal loss.

Method: 43 women with two or more fetal losses were included in this open, prospective study. They were divided into a group of 32 nullipara who have had only miscarriages and a group of 11 women who besides the fetal losses were able to give birth to at least one live newborn. Two control groups were also added: 35 women who were never pregnant and 15 parous who did not have any miscarriage. The presence of lupus anticoagulant was assessed by the Staclot LA clotting test. IgG and IgM isotypes of anticardiolipins and lipoprotein (a) were determined using the immunoenzymatic methods.

Results: Lupus anticoagulant was discovered in only one of 23 examined patients. Abnormally high values of IgG isotype of anticardiolipins were found in two subjects of each control group and in two nullipara with miscarriages only. The increased level of IgM isotype was noted in approx. 50% of patients with recurrent fetal loss, but at least one successful delivery and in control subjects who were never pregnant. In contrast, the frequency of the increased level of this antibody was diminished by half in the remaining two groups: women who delivered a live child (children) without any miscarriage and women who had only miscarriages. Elevated levels of lipoprotein (a) were found in approx. 30% of non-pregnant control subjects and in the patients of both groups; the abnormally high concentration of this lipoprotein was encountered in only 13% of women who gave birth to live newborn(s) and did not have any miscarriage.

Conclusion: Of all four determined variables, only abnormally high values of lipoprotein (a) may have some prognostic significance in women predisposed to the recurrent fetal loss.