Positive ANA and Miscarriage

Dr. Braverman discusses the mechanisms by where patients with positive ANA may miscarry even when they do not have active autoimmune disease or abnormal thyroid functioning.

I see many patients who refer to me for unexplained in vitro fertilization failures or recurrent miscarriages and all that we are able to find was a positive ANA – antinuclear antibody – with no other sign of autoimmune disease. This is where the boat gets missed. Just the presence of positive ANA is a sign that the immune system has a high probability of being involved in these pregnancies losses. Recent literature has shown that populations of patients with recurrent pregnancy loss have significantly high rate of high positive ANA than the general population. In fact, the association is even higher when the positive ANA is associated with a positive antithyroid antibody – even when thyroid function is normal.

So passing all this information and failing to treat these patients for immune related losses is a critical reason for repetitive failures in fertility treatments. The reason for this association is not clear but it is believed that these antibodies actually attached to this invading trophoblast of the embryo and true to the activation of the bodies complement system. The complement system, when activated, leads to a massive influx of inflammatory immune cells that begins the destruction of the embryo through a process called apoptosis.

There are many treatments for this and these losses are usually preventable. Treatments must be carried out even if there was no other side of underlying autoimmune disease which of course must always be ruled out in patients with positive ANAs. In patients that are found to have underlying autoimmune disease, treatment for immune rejection of pregnancies must then and certainly be carried out to assure a chance for success. It is also important to point out that a newly positive ANA found during or immediately after pregnancy may be a sign that the immune system was involved in an attempt to destroy the embryo. Nuclei of destroyed embryotic cells generate an immune response in antibodies to these nuclear components – which is ANA – are produced. If you have a positive ANA regardless whether you were told that there is no autoimmune disease you will most likely require careful evaluation and management of your cycle to avoid recurrent pregnancy loss.

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