Comparison of Pregnancy Outcome between Low Dose Aspirin Alone and Aspirin Plus Prednisolone Treatment in Recurrent Spontaneous Abortion Associated with Antiphospholipid Antibodies

Kim, Chung Hoon; Chae, Hee Dong; Koo, Ja Nam; Kim, Nak Yon; Kang, Byung Moon; Chi, Hyun Sook; Chang, Yoon Seok; Mok, Jung Eun

Abstract

We performed this study to compared pregnancy outcome between low dose aspirin alone and aspirin plus prednisolone treatment in patient of recurrent spontaneous abortion associated with antiphospholipid antibodies. From May 1994 to March 1996, forty-two patients of recurrent spontaneous abortion associated with antiphospholipid antibodies were randomized to receive either low dose aspirin alone(LDA group, n=21) or aspirin plus prednisolone(AP group, n= 21). When pregnancy was confirmed, women were stared with 100mg of aspirin oral daily until 29 weeks of gestation and thereafter 50 mg daily until 35 weeks of gestation in LDA group. In AP group, aspirin administration was same as LDA group and prednisolone was administrated 30 mg oral daily until 24 weeks of gestation and thereafter 10 mg daily until 35 weeks of gestation. Lupus anticoagulant(LAC) was positive in 15 patients, anticardiolipin antibody (ACL) was positive in 24 patients, and both were positive in 3 patients. There was not significant difference in the rate of spontaneous abortion between LDA and AP group[7/21(33.3%) vs 3.21(14.3%)]. There was also no significant difference in live birth rate between LDA and AP groups[14/21(66.7%) vs 18/21(85.7%)]. In LAC positive patients, there was lower rate of live birth in LDA group than in AP group, but not significantly different[4/8(50.0%) vs 6/7(85.7 %)]. In ACL positive patients, there was no significant difference in live birth rate between LDA and AP groups[10/12(83.3%) vs 11/12(91.7%)]. In the case of both LAC and ACL positive patients, there was also no significant difference in live birth rate between LDA and AP group [0/1(0.0%) vs 1/2(50.0%)]. There were no significant difference in mean gestational age and mean fetal body weight at delivery between LDA and AP groups(35.5+/-3.0 vs 36.7+/-2.5 wks, 2546.0+/-685.9 vs 2693.3+/-683.6 gm). There were also no significant difference in the rate of cesarean section due to fetal distress, the rate of Apgar score less than 7 at 5 minutes, the rate of admission to neonatal intensive care unit, and the rate of perinatal mortality between two groups. There was no congenital anomalous fetuses in all study patients. We found that combined treatment of aspirin plus predinisolone might be potentially more effective than low dose aspirin alone in patients of recurrent spontaneous abortion associated with antiphospholipid antibodies, especially in patients of LAC positive.