PREVENTING MISCARRIAGES: AUTO-IMMUNE DISORDERS
These disorders occur when a woman produces antibodies directly against her own cells. The antibodies are thought to cause blood clots in the placenta, preventing the baby getting enough nutrients and blood. Treatment involves drugs that thin the blood, like aspirin and heparin.
An auto-immune condition called systemic lupus erythematosis (SLE) causes chronic inflammation which can affect many systems of the body. One of the world’s leading experts in this disorder is Professor Graham Hughes, Head of the Lupus Arthritis Research Unit at St Thomas’s Hospital in London. His original investigations showed that many lupus sufferers also had a blood clotting syndrome which can be detected through the presence of antiphospholipid antibodies in the blood. Lupus sufferers get pregnant easily but have a high rate of miscarriages. This syndrome has now been called Hughes Syndrome. It is like having ‘sticky blood’, which can trigger a miscarriage by causing blood clots to form in the placenta. It is also thought that, these antibodies can directly attack the cells of the placenta, making implantation difficult. Hughes Syndrome can sometimes be found in women who do not have symptoms of SLE but are having recurrent miscarriages.
The two main antiphospholipid antibodies that need to be tested for are lupus anticoagulant and anticardiolipin antibodies. Professor Lesley Regan, of the Recurrent Miscarriage Clinic at St Mary’s Hospital in London, has pioneered this work on antiphospholipid antibodies and miscarriages. She makes it clear that women need to have a number of tests to determine whether they have positive antibodies, as fluctuations can occur. You can also get false positive readings and so she recommends that women should test positive on at least two occasions, with each test performed at least eight weeks apart.
The treatment of choice for ‘sticky blood’ is aspirin. This has been a surprise because previous studies have linked taking aspirin in pregnancy with children’s heart disease, brain malformations and cleft palates. Very heavy doses have been blamed for preventing normal growth of the lungs and ‘blue baby syndrome’. The difference is that in this treatment the aspirin dose is low – only 76mg daily. The aspirin is given prior to conception and as soon as the woman finds out she is pregnant she is also given the anticoagulant drug heparin.
Trials at St Mary’s have shown that the combination of aspirin and heparin works more effectively than just aspirin alone. As with any drug treatment, one has to weigh up the benefits against the risks: it has been reported that women taking heparin during pregnancy may have an increased risk of osteoporosis (thinning of the bones) and they will need to be monitored. Further larger studies are needed in order to confirm the miscarriage benefits of aspirin and heparin.
Another possibility, instead of either aspirin or heparin, is to use vitamin E. This vitamin can help thin the blood and prevent clots. Aspirin is often recommended for people who are at risk of heart attacks, in order to keep their blood thin and reduce the possibility of a clot. Yet a study published in the Lancet in 1996 found that taking a daily dose of vitamin E reduced the risk of having a heart attack by an astonishing 75 per cent. The scientists heading this study commented that the results were even more ‘exciting than aspirin’. Unfortunately a number of women are now being given aspirin, as a just in case’ measure, without any of the blood tests showing positive to the blood clotting factor.
The recommended dose of vitamin E should be around 400 IU and you should buy the natural form of this vitamin, d-alpha tocopherol.
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Tagged as: Women’s Health
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