LETTER
Antiphospholipid Antibodies in Pregnancy
Eve Scopelitis;
Wendell A. Wilson; and
Myriam C. Perez
1 October 1994 | Volume 121 Issue 7 | Pages 547-548
TO THE EDITOR:
Lynch and colleagues [1] reported a 4.6% frequency of elevated IgG anticardiolipin antibody levels in healthy, low-risk, nulliparous pregnant women. Twenty-eight percent of the group positive for the anticardiolipin antibody experienced fetal loss, indicating that patients with elevated antibody levels (at their initial prenatal visit) have an increased risk for fetal loss. The authors, however, misquoted our earlier abstract [2] regarding an association between anticardiolipin antibody levels and maternal complications of pregnancy. We, as they, found no increase in maternal pregnancy complications.
Our data have now been published [3]; in a predominantly African-American population of 1200 unselected pregnant women, we found an even lower overall positivity (1.25%) for IgG anticardiolipin antibody using a standardized enzyme-linked immunosorbent assay [4]. Unlike in Lynch and colleagues' study, however, an increased frequency of fetal loss occurred in only those patients who had moderate to strongly elevated IgG anticardiolipin antibody titers (>5 standard deviations above the mean). Fifty percent of these patients had at least one fetal loss compared with 20% of women without and 10% of women with low anticardiolipin antibody titers.
In a related study [5], we also found a low prevalence (4 of 72 women [5.6%]) of moderate to high titers of anticardiolipin antibodies in healthy women with a history of first-trimester, recurrent (three or more consecutive) spontaneous abortions.
We therefore agree with the conclusions of Lynch and colleagues that positivity for anticardiolipin antibodies is associated with an increased risk for fetal loss but not for other complications of pregnancy. We also agree that the low rate of positivity in unselected pregnant women argues against screening for the antibodies in women with no risk factors for fetal loss.
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Author and Article Information
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Louisiana State University Medical Center, New Orleans, LA 70112
1. Lynch A, Marlar R, Murphy J, Davila G, Santos M, Rutledge J, et al. Antiphospholipid antibodies in predicting adverse pregnancy outcome. A prospective study. Ann Intern Med. 1994; 120:470-5.
2. Brown HL, Perez MC, Wilson W, Scopelitis E. Anticardiolipin antibodies in an unselected obstetric population: relationship to fetal outcome (Abstract). Society of Perinatal Obstetricians. Tenth Annual Meeting, January 23-27, 1990.
3. Perez MC, Wilson WA, Brown HL, Scopelitis E. Anticardiolipin antibodies in unselected pregnant women: relationship to fetal outcome. J Perinatol. 1991; 11:33-6.
4. Gharavi AE, Harris EN, Asherson RA, Hughes GR. Anticardiolipin antibodies: isotype distribution and phospholipid specificity. Ann Rheum Dis. 1987; 46:1-6.
5. Eroglu GE, Scopelitis E. Antinuclear and antiphospholipid antibodies in healthy women with recurrent spontaneous abortion. Am J Reprod Immun. 1994; 31:1-6.
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