Since 1989, 22 patients with persistent antiphospholipid syndrome (PAPS) associated with recurrent miscarriage (defined as three or more miscarriages) were treated with fish oil, equivalent to 5.1 g eicosapetaenoic acid (EPA) and docosahexaenoic acid (DHA) at a ratio of 1.5 EPA to DHA. Twenty-two patients had 23 pregnancies (one patient had two pregnancies) over a period of 3 years. There was only one intrauterine fetal death at the 27th week associated with pre-eclampsia. Twenty-one pregnancies, 19 of which ended after the 37th week, produced a baby. Two pregnancies ended with cesarean section for pre-eclampsia at 30th and 35th week of gestation and one is ongoing at 32nd week. All babies are well. The weight at birth of babies delivered at term was always >2500 g. These encouraging results favour a therapeutic role, without any adverse reaction, of fish oil to prevent recurrent miscarriage in PAPS.
Rubin D., Laposada M.Cellular interactions between n-6 and n-3 fatty acids: a mass analysis and fatty acid elongation/desaturation, distribution along complex lipids, and conversion to eicosanoids. J Lipid Res1993 ; 25: 166-9.
2.
Goodnight SH , Harris WS, Connor WEThe effects of dietary omega-3 fatty acids on platelet composition and function in man: a prospective, controlled study . Blood1981; 58: 880-5.
3.
Goodnight SHVascular effects of omega-3 fatty acids. InvestDermatol1989; 93: 102-6.
4.
Editorial. Fish oil. Lancet1988; 1: 1081-3.
5.
Schacky CV, Weber PCMetabolism and effects on platelet function of the purified eicosapentaenoic acid and docosahexaenoic acids in humans. J Clin Invest1985; 76: 2446.
6.
Leaf A., Weber PCCardiovascular effects of n-3 fatty acids. N Engl J Med1988; 318: 549-57.
7.
Force T., Milani R., Hibbered P. et al. Aspirin-induced decline in prostacyclin production in patients with coronary artery disease is due to decreased endoperoxide shift. Analysis of the effects of a combination of aspirin and n-3 fatty acids on the eicosanoid profile. Circulation1991 ; 84: 2588-90.
8.
Li X., Steiner M.Fish oil: a potent inhibitor of platelet adhesiveness. Blood1990; 76: 938-45.
9.
Out HJ, Kooijman CD, Bruinse HW, DerksenRHWM. Histopathological findings in placentae from patients with intra-uterine fetal death and anti-phospholipid antibodies. Lupus1992; 1 (Suppl. 1): 72 (abstract).
10.
Lockshin MDAntiphospholipid antibody and pregnancy loss . Lupus1992; 1 (Suppl 1): 12 (abstract).
McNeil HP, Chesterman CN, Krilis SAAnticardiolipin antibodies and lupus anticoagulants comprise antibody subgroups with different phospholipid binding characteristics. Br J Haematol1979; 73: 506-13.
13.
Out Hj, de Groot PG, van Vliet M., de Gast GC, Nieuwenhuis HK, Derksen Rhwm.Antibodies to platelets in patients with antiphospholipid antibodies . Blood1991; 77: 2655-9.
14.
Shi W., Chong BH, Chesterman CNBeta2-glycoprotein I is a requirement for anticardiolipin antibodies binding to activated platelets:differences with lupus anticoagulants. Blood1993; 81: 1255-62.
15.
Bevers EM, Galli M.Cofactors involved in the antiphospholipid syndrome. Lupus1992; 1: 51-3.
16.
Branch DW, Scott JR, Kochenour NK, Hershgold E.Obstetric complications associated with the lupus anticoagulant. N Engl J Med1985; 313: 1322-6.
17.
Roberts JM, Redman CWPre-eclampsia: more than pregnancy-induced hypertension. Lancet1993; 341: 1447-51.
18.
Dyerberg J. , Bang HOPre-eclampsia and prostaglandins. Lancet1985; 1: 1267.
Olsen SFSecher NJA possible preventive effect of low-dose fish oil on early delivery and pre-eclampsia: indications from a 50-year-old controlled trial. Br J Nutr1990; 64: 599-609.
Exner T., Richard KA, Kronenberg HAA sensitive test demonstrating lupus anticoagulant and its behavioural patterns . Br J Haematol1978; 40: 143-51.
23.
Harris ENSyndrome of the black swan. Br J Rheumatol1987; 26: 324-6.
24.
Tan EM, Cohen AS, Fries JF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1982; 25: 1271-7.
25.
Kalman J., Gecse A., Farkas T., Joo F., Telegdy G., Lajata A.Dietary manipulation with high marine fish oil intake of fatty acid composition and arachidonic acid metabolism in rat cerebral microvessels. Neurochem Res1992; 17: 167-72.
26.
Rubin D., Laposata M.Cellular interactions between n-6 and n-3 fatty acids: a mass analysis of fatty acid elongation/desaturation, distribution among complex lipids and conversion to eicosanoids. J Lipid Res1992 ; 33: 1431-40.
27.
McNeil HP, Chesterman CN, Krilis SAAnticardiolipin antibodies and lupus anticoagulants comprise separate antibody subgroups with different phospholipid binding characteristics. Br J Haematol1989; 73: 506-13.
Krause I., Cohen J., Blank M. et al. Distribution of two common idiotypes of anticardiolipin antibodies in sera of patients with primary antiphospholipid syndrome, systemic lupus erythematosus and monoclonal gammopathies. Lupus1992; 1: 91-6.
30.
Scott JR, Rote NS, Branch DWImmunological aspects of recurrent abortion and fetal death. Obstet Gynecol1987; 70: 645-56.
31.
Parke A.The role of IVIG in the management of patients with antiphospholipid antibodies and recurrent pregnancy losses. Clin Rev Allergy1992; 10: 105-18.
Cowchoch FS , Reece EA, Balaban D., Branch DW, Plouffe L.Repeated fetal losses associated with antiphospholipid antibodies; a collaborative randomized trial comparing prednisone with low-dose heparin treatment. Am J Obstet Gynecol1992 ; 166: 1318-23.
34.
Hasegawa I., Takakuwa K., Goto S., Yamada K., Sekizuka N., Kanazawa K., Tanaka K.Effectiveness of prednisolone/aspirin therapy for recurrent aborters with antiphospholipid antibody. Hum Reprod1992 ; 7: 203-7.
35.
Yoshida A., Morozumi K., Koyama K., Fukuda M., Oikawa T.Prednisolone and aspirin therapy for habitual abortion associated with anti-cardiolipin antibody. Ryumachi1992 ; 32: 200-5.
36.
Rosove MH, Tabsh K., Wassestrum H., Howard P., Hahn BH, Kalunian KCHeparin therapy for pregnant women with lupus anticoagulant or anticardiolipin antibodies. Obstet Gynecol1990; 75: 630-4.
37.
Olsen SF, Sorensen JD, Secher NJ et al. Randomised controlled trial of effect of fish-oil supplementation on pregnancy duration. Lancet1992; 339:1003-7.
38.
Peoples League of Health.The nutrition of expectant and nursing mothers in relation to maternal and infant mortality and morbility. J Obstet Gynaecol Br Empire1946; 53: 498-509.
39.
Simopoulos APSummary of the Conference on the Health effects of Poly Unsaturated Fatty Acids in Seafoods. J Nutr1986; 116: 2350-4.
