Autoimmunity Screening Clinically Proven, but Only After at Least Two Losses

William Kutteh, MD, seems confounded by physicians who don’t believe in screening for and treating autoimmunity following recurrent pregnancy loss. “This is not a religious conversion event,” he said, concluding his remarks on the topic at the 2010 American Society for Reproductive Medicine meeting. “There’s a lot of data.”

“Screening for Autoimmunity in Recurrent Pregnancy Loss: Cash Cow or Evidence-Based Medicine?” the session in which Kutteh spoke, pulled a large audience at ASRM and highlighted the profession’s ambivalence about testing for autoimmunity.

Having carefully reviewed the most recent guidelines defining pregnancy, failed pregnancy, and what level of autoimmune response is significant, Kutteh pointed to data to support heparin and aspirin therapy in women with two or more reported losses and autoimmune indications. Administering anticoagulants, he stressed, is effective even well before fetal blood vessels form.

A somewhat more sanguine Richard Scott, Jr, MD, followed Kutteh.

Scott discouraged general testing absent a pregnancy loss. “When antibodies are present in the general population, it may not mean much. You also need a clinical event or problem,” he said.

References:

Additional reading:

Franklin RD, Kutteh WH. Antiphospholipid antibodies (APA) and recurrent pregnancy loss: treating a unique APA positive population. Hum Reprod. 2002;17(11):2981-2985. http://humrep.oxfordjournals.org/content/17/11/2981.full. Accessed November 1, 2010.

Franklin RD, Kutteh WH. Effects of unfractionated and low molecular weight heparin on antiphospholipid antibody binding in vitro. Obstet Gynecol. 2003 March; 101(3):455-462. http://journals.lww.com/greenjournal/Fulltext/2003/03000/Effects_of_Unfractionated_and_Low_ Molecular_Weight.9.aspx. Accessed November 1, 2010.