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REVIEWS |
From the Clinical Immunology Service, Auckland Hospital, Auckland, New Zealand; Departments of Clinical Immunology, and Public Health and Community Medicine, Westmead Hospital, Sydney; Department of Rheumatology, St. George Hospital, Sydney; Department of Public Health and Community Medicine, University of Sydney, Sydney, Australia; and Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.
Address reprint requests to: Marianne Empson, MBChB, M Med (Clin Epi), FRCPA, FRACP, Clinical Immunology Service, Auckland Hospital, Level 2, Building 31, Auckland, New Zealand; E-mail: mariannee{at}adhb.govt.nz.
OBJECTIVE: To explore the effects of interventions given to improve pregnancy outcome in women with antiphospholipid antibodies.
DATA SOURCES: Cochrane Controlled Trials Register, Cochrane Collaboration Pregnancy and Childbirth Group’s Specialized Register of Controlled Trials, EMBASE, and MEDLINE were searched in December 1999.
STUDY SELECTION: Randomized or quasi-randomized controlled trials of therapy for pregnancy loss associated with antiphospholipid antibodies were identified.
TABULATION, INTEGRATION, AND RESULTS: Trial selection, data extraction, and quality assessment were performed by two authors independently. Quantitative analysis of summary data was performed using the fixed- and random-effects models with heterogeneity assessments. Pregnancy loss and adverse neonatal outcomes were the main outcome measures. Ten trials (n = 627) fulfilled the inclusion criteria (of which four lacked adequate allocation concealment). Three trials of aspirin alone showed no significant reduction in pregnancy loss (relative risk [RR] 1.05, 95% confidence interval [CI] 0.66, 1.68). Heparin combined with aspirin (two trials, 140 patients) significantly reduced pregnancy loss compared with aspirin alone (RR 0.46, 95% CI 0.29, 0.71). Prednisone and aspirin resulted in a significant increase in prematurity (RR 4.83, 95% CI 2.85, 8.21) but no significant reduction in pregnancy loss (RR 0.85, 95% CI 0.53, 1.36).
CONCLUSION: Combination therapy with aspirin and heparin may reduce pregnancy loss in women with antiphospholipid antibodies by 54%. Further large, randomized controlled trials with adequate allocation concealment are necessary to exclude significant adverse effects.
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