Guest Author - Krissi Danielsson

Miscarriage causes are still not well understood. While Internet research reveals a number of treatments and speculated causes, the sad fact is that few courses of treatment have been conclusively proven to prevent miscarriages. Controversy surrounds even the most common treatments, such as prescribing progesterone supplements in early pregnancy. Antiphospholipid antibodies, however, are one of the few things that most accept as a proven miscarriage cause.

What are antiphospholipid antibodies?

Antiphosphopid syndrome, or APS, is an autoimmune problem in which specific antibodies attack substances in the blood, making a person more prone to blood clots. The medical details of the syndrome are far too complicated to go into in depth here, not to mention being out of range for my own level of expertise, but interested readers can learn more about the physiological aspects by reading this article on eMedicine.com.

As far as miscarriage, these antibodies have been positively linked with miscarriage by a number of studies. MedicineNet has an abstract available of one such study from 1997 that showed a drastic improvement in the live birth rate when women with antiphospholipid syndrome received treatment.

How do I know if I have antiphospholipid syndrome?

APS does not have any definite symptoms that will let you know if you are at risk. Recurrent pregnancy losses are often one of the first signs of a problem. (The thinking is that very small blood clots circulating in the body will get stuck in the placenta and block the baby from receiving vital nutrients.) Because no real indications exist that would suggest APS, doctors routinely run tests for the antibodies as a part of a routine miscarriage workup. If you see anticardiolipin antibodies or lupus anticoagulant antibodies on your lab form, your doctor is checking for antiphospholipid syndrome.

Be aware, however, that many times antiphospholipid antibodies can be transient in the body. They may be present at one blood test and then absent at the next. For this reason, some doctors will not diagnose antiphospholipid syndrome unless two blood tests turn up positive with an interval of a few weeks or months. Others will treat a woman for APS with just a single positive blood test.

How do doctors treat antiphospholipid syndrome?

The accepted treatment for APS, as described in the above MedicineNet link, is to take low-dose aspirin and heparin injections throughout the pregnancy. This treatment has been shown to lift the live birth rate of women with APS up into the same range as women without it. Some doctors prescribe low-dose aspirin only, particularly in cases that they're not sure whether a woman really has APS or not. Heparin treatment is unpleasant and expensive, and carries some risks, so many avoid prescribing it unless evidence suggests a clear benefit.

Conclusion

APS is an easily treatable and easily detectable cause of miscarriage. Estimates suggest that 15% of women with recurrent losses have APS, and that the treatment may drastically improve pregnancy outcomes. Women with two or more losses should probably consider asking for the blood test to check for APS.