New Study: Predicting Risk of Miscarriage During First Trimester

“Is a healthy pregnancy possible for me?” is a question many women with lupus ask. A new study published in Lupus Science & Medicine adds to research that can help physicians answer, “yes,” to this important question.

Women with lupus are at higher risk for miscarriage and other complications during pregnancy. This is partly because lupus can cause health problems, such as kidney disease, high blood pressure and antiphospholipid antibodies (like lupus anticoagulants) that may increase the risk of a pregnancy loss.

Lupus anticoagulants are antibodies that are directed against coagulation (also known as clotting) protein phospholipid complexes. These antibodies may cause repeated miscarriages, blood clots in the legs or lungs, and stroke or heart attack. This study suggests that testing positive for lupus anticoagulant antibodies in the first three months (the first trimester) of pregnancy is the strongest predictor of pregnancy loss in women with lupus, compared with other pregnancy risk factors associated with lupus.

The study used a single specific test to identify lupus anticoagulant, which was different from an earlier study about pregnancy loss predictors that depended on several different tests to predict miscarriage.

The study also found that testing positive for lupus anticoagulant during the first trimester is more likely to lead to pregnancy loss than having tested positive for the antibody prior to pregnancy, even in women with lupus who have no history of miscarriage.

The study also looked at lupus disease activity and complement levels—the levels of certain proteins that help protect the body against infection. If lupus activity was moderate to high in the first trimester, the risk for pregnancy loss increased. If complement levels were low, the risk for miscarriage also increased.

The bottom line for women with lupus considering pregnancy, according to the study’s authors, is to have a blood test for lupus anticoagulant in the first trimester.

The rate of pregnancy loss for women with lupus has decreased in recent decades as more research has helped physicians understand how lupus affects pregnancy. Women with lupus should work closely with a rheumatologist and a maternal-fetal specialist early in pregnancy, and preferably prior to becoming pregnant, to help ensure a healthy pregnancy.

Read the full study: Lupus anticoagulant, disease activity and low complement in the first trimester are predictive of pregnancy loss