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Previous Volume 337:148-154 July 17, 1997 Number 3 Next

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ABSTRACT

Background Recurrent fetal loss has been well described in women with antiphospholipid antibodies. Such women also often have other autoantibodies commonly found in patients with systemic lupus erythematosus. Treating them with prednisone and aspirin may reduce the risk of fetal loss.

Methods We screened 773 nonpregnant women who had the unexplained loss of at least two fetuses for antinuclear, anti-DNA, antilymphocyte, and anticardiolipin antibodies and for the lupus anticoagulant. Of 385 women with at least one autoantibody, 202 who later became pregnant were randomly assigned in equal numbers to receive either prednisone (0.5 to 0.8 mg per kilogram of body weight per day) and aspirin (100 mg per day) or placebo for the duration of the pregnancy. The women were stratified according to age (18 to 34 years or 35 to 39 years) and the week of gestation at which the previous fetal losses had occurred (<12 or >12 weeks). The primary outcome measure was a successful pregnancy.

Results Live infants were born to 66 women in the treatment group (65 percent) and 57 women in the placebo group (56 percent, P = 0.19). More infants were born prematurely in the treatment group than in the placebo group (62 percent vs. 12 percent, P<0.001). The major side effects of therapy in the mothers were hypertension (treatment group, 13 percent; placebo group, 5 percent; P = 0.05) and diabetes mellitus (15 percent and 5 percent, P = 0.02).

Conclusions Treating women who have autoantibodies and recurrent fetal loss with prednisone and aspirin is not effective in promoting live birth, and it increases the risk of prematurity.

Source Information

From the Department of Medicine, Division of Rheumatology (C.A.L.), the Clinical Epidemiology and Health Care Research Program (C.B.), the Department of Obstetrics and Gynecology (M.E.H., F.P.M., J.W.K.R., D.F.), and the Obstetric Medicine Program (C.A.L., K.S., L.F., C.A.S.), University of Toronto; the Department of Medicine, Division of Rheumatology, Toronto Hospital (C.A.L.); the Department of Medicine, Division of Rheumatology (C.B.), and Wellesley Research Institute (C.B., M.Y.), Wellesley Hospital; the Department of Obstetrics and Gynecology, Women's College Hospital (M.E.H.); and the Department of Obstetrics and Gynecology, Mount Sinai Hospital (F.P.M., J.W.K.R., D.F.) — all in Toronto; and the Department of Biostatistics, Oxford University, Cambridge, United Kingdom (V.F.).

Address reprint requests to Dr. Laskin at 655 Bay St., 18th Fl., Toronto, ON M5G 2K4, Canada.

Full Text of this Article

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Prednisone and Aspirin in Women with Recurrent Fetal Loss
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Extract | Full Text  
N Engl J Med 1997; 337:1629-1630, Nov 27, 1997. Correspondence

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