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Antiphospholipid Antibodies in Pregnancy
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
