|Dr. William L. Matzner of Simi Valley, California|
Miscarriages and Immunotherapy
Some patients are uncomfortable about taking any medication during pregnancy. Rest assured that a competent medical professional will decide all medication and doses after giving it thorough consideration to minimize any drug related side effects.
Aspirin is an antiinflammatory and antiplatelet agent. Should you require low dose aspirin, the recommendation is 80 mg per day, which is equivalent to a baby aspirin.
Heparin, an anticoagulant, is a purifies preparation derived from animal tissue. It is delivered as a subcutaneous injection and a typical dose would be 5000 IU twice a day.
1. Wipe the area with alcohol. Do not rub!
2. Remove cap from needle and gently pick up a well defined fold of skin.
3. Hold the syringe in a dart fashion and insert the needle directly into the skin at a 45-90 degree angle just into the subcutaneous “fatty layer” of the skin.
Important Points to Remember
Prednisone is a corticosteroid. If indicated, you will be asked to take 5 or 10 mg orally twice a day upon confirmation of pregnancy (patients with immune mediated infertility may be on a different schedule). Drug dosage may be adjusted depending upon follow-up blood tests.
Allergy to prednisone is rare, as the human body manufactures a similar compound. In fact prednisone is used to treat moderate to life threatening allergies.
Possible adverse reaction to moderate and high doses of prednisone include fluid and electrolyte imbalance; metabolic disturbances e.g. hyperglycemia or gestational diabetes and osteoporosis; susceptibility to infection; peptic ulcer; behavioral changes e.g. nervousness, insomnia, irritability and mood swings; myopathy; and cataracts.
Prednisone should be used with caution in people with hypertension, congestive heart failure, diabetes mellitus, osteoporosis, ulcerative colitis, ocular herpes and others (please consult with doctor if you have any chronic illness). Osteoporosis can be retarded with calcium supplementation and exercise.
Rapid withdrawal of prednisone may cause fatigue, myalgias, arthralgias, dizziness, hypotension, hypoglycemia and dyspnea. If you experience these symptoms, please contact your doctor.
There are a number of studies that review the use of prednisone during pregnancy and effects on the fetus. The fetus appears to be protected by at least three mechanisms: 1) enzymes in the placenta degrade the drug to an inactive form, 2) prednisone in maternal circulation is bound to a large protein making it harder to cross the placenta and 3) fetal liver is not able to activate prednisone until the end of the second trimester.
Trace amounts of prednisone have been measured in breast milk. Although these quantities are of doubtful clinical significance, your baby's pediatrician should be notified.
Laboratory studies to monitor while on prednisone include complete blood count, chemistries, electrolytes and antinuclear antibody panel.
Immunoglobulin G Infusion
Immunoglobulin G is a preparation of human derived antibodies. In some patients, conventional immunotherapy with aspirin, heparin and paternal white cell immunization may have to be supplemented with this medication. Patients at risk for developing intrauterine growth retardation, oligohydramnios, toxemia, or severe side effects of steroids, or have preexisting maternal disease are prime candidates. If you require this treatment, it is given intravenously three consecutive days monthly during pregnancy.
Immunoglobulin G is contraindicated in patients who are known to have had anaphylactic or severe systemic reaction to human immune globulin. Patients with IgA deficiency should not receive this product.
Side effects to immunoglobulin G include fever, chills, headache, nausea, malaise and back pain. Mild erythema following infiltration at the sire of infusion has been reported.
Laboratory tests that need to be followed while on this treatment are quantitative immunoglobulins and immunophenotype.
Paternal Leukocyte Immunization
Paternal leukocyte immunization (PLI), a purified preparation of husband's white blood cell, is administered intradermally. Because this is a blood product, the recipient (wife) risks acquiring infectious diseases that donor (husband) may harbor. Rh sensitization is also possible; however, extensive steps are taken to prevent this.
Most women will experience redness and itching at the site of immunization. Please notify your doctor if you have any unexpected or serious reaction.
Maternal antipaternal leukocyte antibodies (blocking antibodies), by flow cytometry, should be followed to monitor efficacy of treatment.
***About William L. Matzner, M.D., PhD, FACP
Dr. William Matzner works in the area of healthcare economics consulting at Healthcare Analytics, LLC, in California. He graduated Phi Beta Kappa from Stanford University. He received his M.D. with Honors from Baylor College of Medicine. In 1988, he was the Solomon Scholar for Resident Research at Cedar Sinai Medical Center. Dr. Matzner subsequently was awarded a PhD in Neuro Economics from Claremont Graduate University. He is board certified in Internal Medicine and Palliative Medicine. He has researched and published extensively on the issue of reproduction and immunology in medical literature. He has been in private practice since 1989, specializing in Reproductive Immunology and Internal medicine.