Anticardiolipin antibodies in patients of Explained Vs Unexplained Abortions

Background : Abortion is termination of pregnancy by any means before the fetus is sufficiently developed to survive on its own. The growing recognition that in this group of patients there may be an immunologic basis aroused interest in research workers. The anticardiolipin antibodies (aCL) which are commonly associated with recurrent pregnancy loss are lgG and lgM. lgM antibody is the largest immunoglobulin and first to appear in an immune response. Women with phospholipid antibodies have a fetal loss of 90% when no specific treatment is given during pregnancy so this study was planned to find anticardiolipin antibody levels (IgM & IgG) in patients of Abortions. Material/Methods: A total of 125 pregnant subjects were included in the study which includes study group (75 subjects) and a control group (50 subjects). Their blood was tested to assess the levels of IgM & IgG aCL by enzyme-linked immunosorbent assay (ELISA). Result : IgG anticardiolipin antibodies were raised in 16.66% of explained vs. 30.7% of unexplained abortion. IgM anticardiolipin antibodies were raised in 83.3% of the explained vs. 4.35% of unexplained abortions. Conclusion : Patients with increased IgM & IgG levels indicate a higher antibody burden with greater antigenic affinities explaining IgM & IgG mediated pregnancy wastage. Introduction Abortion is termination of pregnancy by any means before the fetus is sufficiently developed to survive on its own. This corresponds to a gestational age of 20 weeks or a fetal weight of 500 gms. When abortion occurs spontaneously, the term miscarriage has been applied. The incidence of spontaneous abortion has commonly been quoted as 10% of all the pregnancies . A number of immunologic and non-immunologic factors have been implicated as probable causes of abortions. Current methods of detection do not find any recognized causes in 40-50% of the patients with recurrent abortions (Harris et al 1983) 1 .The growing recognition that in this group of patients there may be an immunologic basis aroused interest in research workers. The antiphospholipid antibodies are gaining importance as a potential cause of recurrent pregnancy loss and their presence in these is clearly documented. The antiphospholipid antibodies were first detected by Wasserman in 1906 2. The term antiphospholipid antibodies include three types of antibodies i.e. anticardiolipin (aCL), lupus anticoagulant and the antibodies causing false positive test for syphilis. The antiphoshoplipid antibodies are a diverse family of autoantibodies which share a common reactivity with negatively charged phospholipids. Although all three are associated independently with fetal loss, aCL are seen to have a definite edge over the other two. Cardiolipin is a doubly negatively charged phospholipid held together by a glycerol linkage. It reacts with a lipid part of bovine heart and hence the name cardiolipin. It is a part of the antigen used in the VDRL assay. It is due to this reason that antibody to cardiolipin brings about a biological false positive reaction in the VDRL test for syphilis. They play a crucial role in the coagulation abnormalities and are associated with scattered placental infarctions, arterial and venous thrombosis, mild thrombocytopenia and connective tissue disease 3 (Elias et al 1984). The presence of anticardiolipin antibodies with one or more of the above clinical manifestations is referred to as Antphospholipid syndrome (Silver et al 1994).4 The aCL which are commonly associated with recurrent pregnancy loss are lgG and lgM. These immunoglobulins are serum glycoproteins that are produced by plasma cells in response to antigens. lgG, the most abundant of the antibodies (80% of all circulating immunoglobulin’s), circulates in the body fluids and is the immunoglobulin which crosses the placenta and provides passive immunity to the fetus. Elevated lgG anticardiolipin antibodies have also been detected in patients with autoimmune disorders such as primary Sjogrens syndrome, mixed connective tissue disease, rheumatoid arthritis, idiopathic thrombocytopenic purpura, Bechet’s syndrome, Myasthenia gravis and other undefined autoimmune disorders (Harris et al 1985)5. lgM antibody is the largest immunoglobulin and first to appear in an immune response. It constitutes approximately 10% of normal immunoglobulin’s. High level of lgM anticardiolipin appear to be more distributed than lgG anticardiolipin antibodies and have been found in autoimmune, drug induced and infectious disorders including some patients with syphilis. The antiphospholipid antibodies act via myriad of prothrombotic mechanisms to bring about thrombosis and infarction of the placental vasculature, thereby causing fetal compromise and death. The antibodies might affect platelet membranes leading to subtle and sometimes non-subtle changes in platelet function 6 (Hughes et al 1986). The antibodies might damage the endothelial cell membranes, leading to decreased prostacyclin release. Prostacyclin is a vasodilator which prevents platelet aggregation. Any decrease in the former leads to increased thrombosis 7 (Carreras et al 1981). Women with phospholipid antibodies have a fetal loss of 90% when no specific treatment is given during pregnancy. MATERIALS AND METHODS The study was conducted in the Department of Anatomy and the subjects for the study were obtained from the Department of Obstetrics and Gynaecology of Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital and Kalawati-Saran Children’s Hospital. New Delhi. A total of 125 subjects were for the study. A total of 125 pregnant subjects were included in the study which includes study group (75 subjects) and a control group (50 subjects). Subjects in the Study group included patients with a history of two or more first trimester or second trimester spontaneous abortions who were otherwise healthy without any obvious medical or surgical cause for the pregnancy loss. Con-