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.
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.
Authors: Sunni L Mumford; Robert M Silver; Lindsey A Sjaarda; Jean Wactawski-Wende; Janet M Townsend; Anne M Lynch; Noya Galai; Laurie L Lesher; David Faraggi; Neil J Perkins; Karen C Schliep; Shvetha M Zarek; Enrique F Schisterman Journal: Hum Reprod Date: 2016-01-11 Impact factor: 6.918
Authors: Enrique F Schisterman; Robert M Silver; Neil J Perkins; Sunni L Mumford; Brian W Whitcomb; Joseph B Stanford; Laurie L Lesher; David Faraggi; Jean Wactawski-Wende; Richard W Browne; Janet M Townsend; Mark White; Anne M Lynch; Noya Galai Journal: Paediatr Perinat Epidemiol Date: 2013-10-11 Impact factor: 3.980
Authors: Megan E B Clowse; Amanda M Eudy; Elizabeth Kiernan; Matthew R Williams; Bonnie Bermas; Eliza Chakravarty; Lisa R Sammaritano; Christina D Chambers; Jill Buyon Journal: Rheumatology (Oxford) Date: 2018-07-01 Impact factor: 7.580