Historically, repeat pregnancy loss associated with antiphospholipid antibodies was treated with combinations of prednisone and aspirin. The rationale for prednisone therapy is suppression of autoantibodies such as antiphospholipid and antinuclear antibodies. A study comparing live birth rates in women treated with heparin and aspirin with prednisone and aspirin showed 75% live births in both groups. However, both maternal complications and preterm delivery with premature rupture of membranes and toxemia of pregnancy were significantly higher in pregnant women treated with prednisone and aspirin compared with heparin and aspirin. Other side effects of steroid medication include fluid retention, weight gain and mood changes. Therefore, the current recommendation for “first attempt” treatment for repeat pregnancy loss associated with antiphospholipid antibodies is heparin and aspirin.
