women of childbearing age are often first diagnosed with aps when they seek medical treatment for recurrent pregnancy loss . at present , recurrent miscarriage ( rm ) is generally defined as the loss of two or more pregnancies with the same partner before the first 24 weeks of gestation . while the cause of rm is indeterminable in 50% of patients , aps is one of the main causes of miscarriages in 15% of patients . most women suffering from rm require curettage treatment , which can lead to infertility and have a serious impact on women 's physical and mental health . even if patients with both aps and a history of rm do become pregnant , they face a risk of serious obstetric complications such as pre - eclampsia and hellp syndrome ( hemolysis , elevated liver enzymes , and low platelets ) , which can be life - threatening to both mother and the fetus . the etiology of aps is far - ranging , and the exact pathogenesis of the disease is not yet clear . at present , etiological research has focused mainly on the release of inflammatory cytokines , enhanced platelet aggregation , coagulation abnormalities , and trophoblast cell damage , all of which are induced by the interactions between antiphospholipid antibodies and trophoblast cells , endothelial cells , and lymphocytes . wang et al . studied the placental anatomy of miscarriage patients with aps and found diffuse thrombosis in the uterine spiral artery and other small vessels . based on these findings , anticoagulation is regarded as the core treatment for aps patients . common medications include prednisone , aspirin , and heparin . combinations of these drugs are considered better than single - drug treatments , and the live birth rate for pregnant patients undergoing this treatment is 7379% . however , it is recommended that medication should be administered from the time pregnancy is confirmed until 6 weeks postpartum . so far , the relationship between antiphospholipid antibody titers during treatment and pregnancy outcomes has not been described in detail . therefore , as a treatment strategy for aps patients with rm , we prospectively prescribed prednisone and aspirin before pregnancy and low - molecular - weight heparin ( lmwh ) once pregnancy was confirmed . the isotype of antiphospholipid antibodies , changes in antibody titers during treatment , time of medicine discontinuance , reported side effects , and pregnancy outcomes were evaluated to analyze the relationship between changes in antibody and clinical outcomes . this study should provide a reference for the evaluation of therapeutic effects and the clinical treatment of patients with aps and rm . patients who were diagnosed with aps and rm at the reproductive medicine center of the peking university third hospital ( beijing , china ) between march 2012 and may 2014 were enrolled in this study ( n = 123 ) . patients with abnormal uterine anatomy , endocrine abnormalities , or parental chromosome abnormalities were excluded . the clinical diagnosis was based on the standard from the sapporo international conference in 2006 . according to these criteria , at least one clinical and one laboratory test must be met for a diagnosis of aps . due to the fact that our clinical laboratory can only measure the igg and igm isotypes of anticardiolipin and anti-2-glycoprotein 1 ( anti-2-gp1 ) antibodies , these were used as the screening indexes for aps . this study was approved by the institutional review board of peking university third hospital and was conducted according to the tenets of the declaration of helsinki and its revisions . blood samples were sent to the clinical laboratory at peking university third hospital and tested using an enzyme - linked immunosorbent assay kit from euroimmun ( germany ) . the test kit included microplates , standard 1 ( 120pl - igg / igm - u / ml ) , standard 2 ( 12pl - igg / igm - u / ml ) , standard 3 ( 2pl - igg / igm - u / ml ) , negative and positive controls , peroxidase - conjugated rabbit anti - human igg / igm , sample buffer , wash buffer , and stop solution . serum samples were diluted 1:20 in sample buffer . for quantitative detection , standards 1 , 2 , and 3 the upper limit of detection for anticardiolipin antibodies is 12 plu / ml , and the detection limit for anti-2-gp1 antibodies is 20 ru / ml . patients chosen according to the inclusion criteria were pretreated with a low dose of prednisone ( 5 mg once a day [ qd ] by mouth [ po ] ) and aspirin ( 75 mg qd po ) for 2 months . during this period pregnancies were confirmed by the date of the last menstrual cycle and by changes in human serum chorionic gonadotropin ( hcg ) levels . lmwh ( 4100 international units qd , subcutaneously [ sc ] ) was added to the regimen . the antiphospholipid antibody titer was measured at the beginning and end of the 2-month pretreatment period and at about 6 weeks in early pregnancy . during pregnancy , the antiphospholipid antibody titer , platelet aggregation rate , and d - dimer level were tested monthly to adjust the drug dosage , while symptoms such as vaginal bleeding were monitored . if the antibody test was negative two times in a row , all medication was stopped . moreover , if patients showed obvious bleeding , aspirin and lmwh were stopped or the dosage was reduced and the pregnancy was strictly monitored . to avoid the side effects of hormone treatment , whose pregnancies resulted in a live birth , information on the newborn , including gender , birth weight , and fetal development , was recorded . pregnancy - related complications were also analyzed in the live birth group , including preeclampsia , gestational diabetes , premature delivery ( delivery between 28 and 37 weeks of pregnancy ) , premature rupture of membranes ( spontaneous rupture of membranes before the onset of labor ) , and postpartum hemorrhage ( bleeding reaches 500 ml for vaginal delivery and 1000ml for cesarean sections ) . preeclampsia occurring after week 20 of pregnancy was defined as systolic blood pressure 140 mm hg and/or diastolic pressure 90 mm hg , with urinary protein 0.3 g per 24 h. gestational diabetes mellitus ( during 2428 weeks of pregnancy ) was diagnosed as blood glucose values of 5.1 mmol / l , 10.0 mmol / l , and 8.5 mmol / l before , 1 h after , and 2 h after the 75 g oral glucose tolerance test , respectively . side effects associated with the medication , such as allergy , serious bleeding , and subcutaneous ecchymosis , were also recorded . the major statistical tests applied were the independent t - test , rank test , chi - square test , and repeated variance analysis . a value of p < 0.05 was considered statistically significant . patients who were diagnosed with aps and rm at the reproductive medicine center of the peking university third hospital ( beijing , china ) between march 2012 and may 2014 were enrolled in this study ( n = 123 ) . patients with abnormal uterine anatomy , endocrine abnormalities , or parental chromosome abnormalities were excluded . the clinical diagnosis was based on the standard from the sapporo international conference in 2006 . according to these criteria , at least one clinical and one laboratory test must be met for a diagnosis of aps . due to the fact that our clinical laboratory can only measure the igg and igm isotypes of anticardiolipin and anti-2-glycoprotein 1 ( anti-2-gp1 ) antibodies , these were used as the screening indexes for aps . this study was approved by the institutional review board of peking university third hospital and was conducted according to the tenets of the declaration of helsinki and its revisions . blood samples were sent to the clinical laboratory at peking university third hospital and tested using an enzyme - linked immunosorbent assay kit from euroimmun ( germany ) . the test kit included microplates , standard 1 ( 120pl - igg / igm - u / ml ) , standard 2 ( 12pl - igg / igm - u / ml ) , standard 3 ( 2pl - igg / igm - u / ml ) , negative and positive controls , peroxidase - conjugated rabbit anti - human igg / igm , sample buffer , wash buffer , and stop solution . serum samples were diluted 1:20 in sample buffer . for quantitative detection , standards 1 , 2 , and 3 were incubated with positive control , negative control , or patient serum . the upper limit of detection for anticardiolipin antibodies is 12 plu / ml , and the detection limit for anti-2-gp1 antibodies is 20 ru / ml . patients chosen according to the inclusion criteria were pretreated with a low dose of prednisone ( 5 mg once a day [ qd ] by mouth [ po ] ) and aspirin ( 75 mg qd po ) for 2 months . during this period pregnancies were confirmed by the date of the last menstrual cycle and by changes in human serum chorionic gonadotropin ( hcg ) levels . lmwh ( 4100 international units qd , subcutaneously [ sc ] ) was added to the regimen . the antiphospholipid antibody titer was measured at the beginning and end of the 2-month pretreatment period and at about 6 weeks in early pregnancy . during pregnancy , the antiphospholipid antibody titer , platelet aggregation rate , and d - dimer level were tested monthly to adjust the drug dosage , while symptoms such as vaginal bleeding were monitored . if the antibody test was negative two times in a row , all medication was stopped . moreover , if patients showed obvious bleeding , aspirin and lmwh were stopped or the dosage was reduced and the pregnancy was strictly monitored . to avoid the side effects of hormone treatment , whose pregnancies resulted in a live birth , information on the newborn , including gender , birth weight , and fetal development , was recorded . pregnancy - related complications were also analyzed in the live birth group , including preeclampsia , gestational diabetes , premature delivery ( delivery between 28 and 37 weeks of pregnancy ) , premature rupture of membranes ( spontaneous rupture of membranes before the onset of labor ) , and postpartum hemorrhage ( bleeding reaches 500 ml for vaginal delivery and 1000ml for cesarean sections ) . preeclampsia occurring after week 20 of pregnancy was defined as systolic blood pressure 140 mm hg and/or diastolic pressure 90 mm hg , with urinary protein 0.3 g per 24 h. gestational diabetes mellitus ( during 2428 weeks of pregnancy ) was diagnosed as blood glucose values of 5.1 mmol / l , 10.0 mmol / l , and 8.5 mmol / l before , 1 h after , and 2 h after the 75 g oral glucose tolerance test , respectively . side effects associated with the medication , such as allergy , serious bleeding , and subcutaneous ecchymosis , were also recorded . all statistical analyses were done using spss 16.0 ( spss inc . , usa ) . the major statistical tests applied were the independent t - test , rank test , chi - square test , and repeated variance analysis . a value of p < 0.05 was considered statistically significant . of 123 patients , 99 had successful pregnancies , of which 87 resulted in live births , for an overall success rate of 87.9% ( 87/99 ) . there were 12 cases of miscarriage and 24 patients who did not become pregnant by the time the data were collected . specifically , the live birth group included four cases of preterm labor ( 4% ) and 83 cases of full - term birth ( 83.8% ) , while the miscarriage group included one case of biochemical pregnancy ( 1% ) and 11 cases of embryo damage ( 11.1% ) . , chorionic chromosome testing was performed , and three abnormal results were found : tetraploid karyotype , trisomy 18 , and trisomy 16 . all 123 patients were positive for anti-2-gp1 igm while 13 of the 123 patients ( 10.6% ) were also positive for anticardiolipin igm . anti - phospholipid antibody types data are given as the number of patients in the treatment . the live - birth group ( n = 87 ) : received prednisone 5 mg + aspirin 75 mg + lwmh 4100iu daily ; miscarriage group ( n = 12 ) : received prednisone 5 mg+aspirin 75 mg + lwmh 4100iu daily ; infertility group ( n = 24 ) : received prednisone 5 mg + aspirin 75 mg daily . age , body mass index ( bmi ) , and antibody titers before pretreatment , after 2-month pretreatment , and during early pregnancy were analyzed using spss version 16.0 [ table 2 ] . given that 100% of patients were positive for anti-2-gp1 igm , this antibody was used as the representative index for the analysis of antiphospholipid antibody titers . there was no significant difference in age , bmi , or history of pregnancy loss between the two groups ( p > 0.05 ) . the time until pregnancy in the miscarriage group was longer than that in the live birth group ( p < 0.001 ) . the antibody titer before medication in the live birth group was higher than that in the miscarriage group ( p < 0.05 ) . after 2 months of pretreatment , the antibody titer had gradually decreased in both groups and was lower in the live birth group than in the miscarriage group ( p < 0.05 ) . the percentage of patients who were negative for antiphospholipid antibodies was slightly lower in the live birth group than in the miscarriage group ( p < 0.05 ) . in early pregnancy , the live birth group had a lower average antibody titer and a higher proportion of patients who were negative for antiphospholipid antibodies ( p < 0.05 ) . changes in anti-2-gp1 antibodies under medication data are given as mean  sd , or different value ( % ) . sd : standard deviation ; * wilcoxon rank sum test ; chi - square test . time spent until pregnancy : the number of months from the start of medication until the confirmation of pregnancy ; the negative rate : the number of cases in which the antibody titer was negative out of the total number of cases in the group . in the live birth group , titer values were analyzed at the three time points by the paired t - test . the results showed that there were significant differences between each of the two titer values ( p < 0.05 ) , indicating that the medication effectively downregulate the serum level of antiphospholipid antibody in the patients . in addition , using the same analysis , similar results were obtained in the miscarriage group . furthermore , we found that , at each time point , the titer levels in the two groups were significantly different ( p < 0.001 ) . figure 1 shows the change in the average antiphospholipid antibody titers in both miscarriage group and live birth group . the decrease in antiphospholipid antibodies was significantly lower in the miscarriage group than in the live birth group ( p < 0.001 ) . change in the average antiphospholipid antibody titers in both miscarriage group and live birth group . after 2 months of pretreatment , each of the patients tested negative , and no recurrences were detected . with respect to the 24 patients who were not pregnant at the time the data were analyzed , the average antibody titer before pretreatment was 55.0  52.0 ru / ml , and no significant differences in antibody titer were found after 2 months of pretreatment ( 56.6  32.1 ru / ml ; p = 0.802 ) . in the live birth group , low - dose prednisone was stopped at 930 weeks of pregnancy ( average , 17.9  4.7 weeks ) , and aspirin was stopped at 1031 weeks ( average , 19.2  5.0 weeks ) . moreover , lmwh was stopped at 936 weeks ( average , 22.5  6.9 weeks ) . during the treatment of the 87 live births , 83 were full - term pregnancies , and the average birth weight was 3314  200 g. the remaining four infants were born preterm as follows : male , 32 weeks , 2300 g ; male , 34 weeks , 2705 g ; male , 36 weeks , 2960 g ; and female , 36 weeks , 2650 g. follow - up interviews were conducted by phone , and no obvious developmental abnormalities in these newborns were revealed . with respect to pregnancy complications , three cases of preeclampsia , one case of gestational diabetes mellitus , and six cases of premature rupture of membranes occurred in the 87 live birth patients . based on analyses of medical records and the telephone follow - up interviews , of 123 patients , 99 had successful pregnancies , of which 87 resulted in live births , for an overall success rate of 87.9% ( 87/99 ) . there were 12 cases of miscarriage and 24 patients who did not become pregnant by the time the data were collected . specifically , the live birth group included four cases of preterm labor ( 4% ) and 83 cases of full - term birth ( 83.8% ) , while the miscarriage group included one case of biochemical pregnancy ( 1% ) and 11 cases of embryo damage ( 11.1% ) . , chorionic chromosome testing was performed , and three abnormal results were found : tetraploid karyotype , trisomy 18 , and trisomy 16 . all 123 patients were positive for anti-2-gp1 igm while 13 of the 123 patients ( 10.6% ) were also positive for anticardiolipin igm . anti - phospholipid antibody types data are given as the number of patients in the treatment . the live - birth group ( n = 87 ) : received prednisone 5 mg + aspirin 75 mg + lwmh 4100iu daily ; miscarriage group ( n = 12 ) : received prednisone 5 mg+aspirin 75 mg + lwmh 4100iu daily ; infertility group ( n = 24 ) : received prednisone 5 mg + aspirin 75 mg daily . age , body mass index ( bmi ) , and antibody titers before pretreatment , after 2-month pretreatment , and during early pregnancy were analyzed using spss version 16.0 [ table 2 ] . given that 100% of patients were positive for anti-2-gp1 igm , this antibody was used as the representative index for the analysis of antiphospholipid antibody titers . there was no significant difference in age , bmi , or history of pregnancy loss between the two groups ( p > 0.05 ) . the time until pregnancy in the miscarriage group was longer than that in the live birth group ( p < 0.001 ) . the antibody titer before medication in the live birth group was higher than that in the miscarriage group ( p < 0.05 ) . after 2 months of pretreatment , the antibody titer had gradually decreased in both groups and was lower in the live birth group than in the miscarriage group ( p < 0.05 ) . the percentage of patients who were negative for antiphospholipid antibodies was slightly lower in the live birth group than in the miscarriage group ( p < 0.05 ) . in early pregnancy , the live birth group had a lower average antibody titer and a higher proportion of patients who were negative for antiphospholipid antibodies ( p < 0.05 ) . changes in anti-2-gp1 antibodies under medication data are given as mean  sd , or different value ( % ) . sd : standard deviation ; * wilcoxon rank sum test ; chi - square test . time spent until pregnancy : the number of months from the start of medication until the confirmation of pregnancy ; the negative rate : the number of cases in which the antibody titer was negative out of the total number of cases in the group . in the live birth group , titer values were analyzed at the three time points by the paired t - test . the results showed that there were significant differences between each of the two titer values ( p < 0.05 ) , indicating that the medication effectively downregulate the serum level of antiphospholipid antibody in the patients . in addition , using the same analysis , similar results were obtained in the miscarriage group . furthermore , we found that , at each time point , the titer levels in the two groups were significantly different ( p < 0.001 ) . figure 1 shows the change in the average antiphospholipid antibody titers in both miscarriage group and live birth group . the decrease in antiphospholipid antibodies was significantly lower in the miscarriage group than in the live birth group ( p < 0.001 ) . change in the average antiphospholipid antibody titers in both miscarriage group and live birth group . after 2 months of pretreatment , each of the patients tested negative , and no recurrences were detected . with respect to the 24 patients who were not pregnant at the time the data were analyzed , the average antibody titer before pretreatment was 55.0  52.0 ru / ml , and no significant differences in antibody titer were found after 2 months of pretreatment ( 56.6  32.1 ru / ml ; p = 0.802 ) . in the live birth group , low - dose prednisone was stopped at 930 weeks of pregnancy ( average , 17.9  4.7 weeks ) , and aspirin was stopped at 1031 weeks ( average , 19.2  5.0 weeks ) . moreover , of the 87 live births , 83 were full - term pregnancies , and the average birth weight was 3314  200 g. the remaining four infants were born preterm as follows : male , 32 weeks , 2300 g ; male , 34 weeks , 2705 g ; male , 36 weeks , 2960 g ; and female , 36 weeks , 2650 g. follow - up interviews were conducted by phone , and no obvious developmental abnormalities in these newborns were revealed . with respect to pregnancy complications , three cases of preeclampsia , one case of gestational diabetes mellitus , and six cases of premature rupture of membranes occurred in the 87 live birth patients . based on analyses of medical records and the telephone follow - up interviews , anti-2-gp1 ig - m antibodies were the predominant form of antiphospholipid antibody in patients with rm and aps in this study . in addition , it is the first time that we report a correlation between the change in antiphospholipid antibody titer during treatment and the pregnancy outcome . during the treatment process , we observed that the more the antibody titers decreased , the more likely patients were to experience a successful outcome . moreover , in the present study , the treatment with low - dose prednisone combined with aspirin and lmwh resulted in a pregnancy success rate of 87.9% ( 87/99 ) , which indicates that the shorter treatment regimen can improve the pregnancy outcome in an effective way . antigen - antibody recognition is a key to the immune response , and the main antigens in aps are cardiolipin and phospholipid acid , which are located on the cell membrane . because lipids are weak in antigenicity , the production of antibodies requires proteins or carbohydrates as carriers . 2-gp1 , which is synthesized by liver cells , is a protein normally found in the human plasma that inhibits the activation of coagulation factor x and xi , regulates the coagulation pathway , and reduces the occurrence of abnormal coagulation events . recent research indicates that 2-gp1 acts as a cofactor for phospholipids to successfully trigger an immune reaction . 2-gp1 plays an auxiliary role in the binding of antiphospholipid antibodies to their corresponding antigens . when 2-gp1 binds to negatively charged phospholipids on the cell membrane , the glycoproteins become phospholipid - protein binding complexes through conformational changes that expose the key sites to which antiphospholipid antibodies bind . another study revealed that 2-gp1 may also be the main antigen for anticardiolipin antibodies . in an in vitro experiment , researchers found that , without 2-gp1 , anticardiolipin antibodies isolated from aps patients serum bound to cardiolipin . however , when 2-gp1 was added , anticardiolipin antibodies had a higher affinity for 2-gp1 than for cardiolipin . during the process of zygote implantation , 2-gp1 combined with phospholipid on the trophocyte membrane ; anti-2-gp1 antibodies therefore damaged the trophocyte and caused pregnancy loss . by retrospectively analyzing 152 healthy women , 141 women with recurrent spontaneous abortion ( rsa ) but without aps , 58 women with a history of fetal death , and 73 women with aps , richard reported that anti-2-gp1 antibody titers in the aps patients were significantly higher than in the other three groups ( p < 0.001 ) . in addition , the percentage of aps patients with anti-2-gp1 antibodies of the igm isotype was higher than the percentage in the rsa group , fetal death group , and fertile control group , whereas there were no statistically significant differences in the percentage of anti-2-gp1 antibodies of the igg isotype between the four groups , which is in accordance with the results reported in this paper . when we reviewed the literature , we could not find reports of pathogenic phenotypes linked to the igg and igm types of anti-2-gp1 antibody moreover , anti-2-gp1 and anticardiolipin antibodies of the igg type were rarely observed in our study . as for the treatment regimen , before treatment , the antibody titer in the live birth group was higher than in the miscarriage group . during treatment , however , the titer in the patients who went on to experience successful pregnancies decreased more rapidly , and the time to conception was also shorter . in addition , in the treatment , no significant decrease in antibody titers was observed after treatment in the patients who did not conceive . therefore , the odds of a successful pregnancy were relatively low in patients who did not show an effective decrease in antibody titer after pretreatment . out et al . also reported that antiphospholipid antibody levels were closely related to adverse obstetric outcomes . we found that the extent of the decrease in the antibody titer was associated with pregnancy outcomes . because of its ability to inhibit antibody formation , prednisone has long been used in the treatment of rm and aps . the use of prednisone in aps patients with rm was first reported by lubble in 1993 , but the regimen was not recommended because of maternal complications caused by the high dose of the medication ( 40 mg daily ) . clinically , 510 mg of prednisone is administered once per day to avoid side effects . in this study , we only administered 5 mg of prednisone po once per day , and the medication was continued for 17.9  4.7 weeks into pregnancy . the main side effects of prednisone include obesity and liver dysfunction , which did not occur in our study . recently , the british society for rheumatology reported that it is viable and safe to use prednisone during preconception and pregnancy , and even during lactation , because very little is secreted in the breast milk . in china , lin recommended that the medication should be started as soon as pregnancy is confirmed and continued until 12 weeks after a negative antibody test . for patients whose antibody titers remain positive , prednisone should not be stopped . to avoid side effects of prednisone , we did not continue medication for more than 30 weeks into pregnancy , even if the antibody titer did not turn negative . in the past 20 years combining low - dose prednisone with aspirin and heparin improves pregnancy outcomes . in the present study , treatment with low - dose prednisone combined with aspirin and lmwh resulted in a pregnancy success rate of 87.9% ( 87/99 ) because of the elevated coagulation status , patients with aps face a greater risk of thrombosis during pregnancy . by comparing the placenta of fetal growth restriction in patients with and without aps , out et al . reported a significantly higher rate of placental thrombosis in aps patients . in that study , of 16 aps patients , the authors found 13 cases of placental microcirculation thrombosis and/or placental infarct formation . since 2000 , researchers have gradually reached a consensus that the hypercoagulable state is a primary cause of adverse pregnancy events such as placental thrombosis . heparin and aspirin are administered because of their effects on coagulation . besides its ability to inactivate coagulation factors , heparin can also block the ability of antiphospholipid antibodies to bind to trophoblast cells , thereby increasing trophoblast cell invasion and differentiation . furthermore , di simone et al . found that one mechanism for the pathogenesis of aps is hyperactivation of the complement system , a process that can be blocked by heparin . heparin was also found to inhibit the activation of the complement system and prevent pregnancy loss in mice with aps . the main side effects of heparin on patients are allergic reactions and bleeding , which were not seen during the present study . lmwh was discontinued at 22.5  6.9 weeks of pregnancy and was not used during the postpartum period , which was not only effective but also economical . besides heparin , aspirin is also a main therapeutic for the treatment of aps and rm . by inhibiting platelet aggregation and decreasing the activity of prostaglandin synthase , aspirin can effectively reduce thrombosis . in a 1988 study , oral aspirin ( qd 75 mg ) after the application of aspirin , the rate of live births improved significantly , from 10% before treatment to 88% . the most frequent side effects are peptic ulcers and bleeding , but no adverse events of aspirin therapy occurred in this study , and aspirin was stopped at 19.2  5.0 weeks of pregnancy . kutteh reported that 25 aps patients with rms treated by oral aspirin ( 81 mg / d ) before conception or subcutaneous injections of heparin ( 5000 units twice daily ) to them once confirmed pregnancy at average of 5.3  1.1 gestational weeks by tests of human chorionic gonadotropin with any missed period . the live birth rate was 80% ( 20 patients ) . for main gestational complications , the occurrence rates of diabetes mellitus , postpartum bleeding , and preeclampsia were 10% , 15% , and 10% , respectively . in our study , because aspirin and heparin were administered over a shortened period and only a half dosage of lmwh was administered via daily subcutaneous injection ( compared with the dosage used in the previously mentioned study ) , no postpartum bleeding or obvious medical side effects occurred . in conclusion , this is the first study in which low - dose prednisone and aspirin were used to pretreat rm patients with aps before pregnancy . these results show that the shorter treatment regimen can effectively reduce antibody titers and improve pregnancy outcomes .
background : the management of patients with recurrent miscarriage ( rm ) and antiphospholipid antibody syndrome ( aps ) includes prolonged treatment with heparin and aspirin , starting from the confirmation of pregnancy and continuing until 6 weeks after birth . 
 this study was conducted to determine the relationship between changes in antiphospholipid antibody titers and clinical outcomes . 
 the effect of a shortened treatment regimen was also evaluated.methods:a prospective study of 123 patients with rm and aps between march 2012 and may 2014 was conducted . 
 patients were pretreated with a low dose of prednisone plus aspirin before pregnancy , and heparin was added after conception . 
 the levels of antiphospholipid antibodies and pregnancy outcomes were evaluated.results:all patients were positive for anti-2-glycoprotein 1 ( anti-2-gp1 ) igm . 
 after prepregnancy treatment with low - dose prednisone plus aspirin , 99 of 123 patients became pregnant , and 87 of those pregnancies resulted in successful live births , while 12 resulted in miscarriage , showing a success rate of 87.9% . in the live birth group , levels of anti-2-gp1 were 56.8  49.0 ru / ml before the pretreatment regimen , 32.1  26.0 ru / ml after 2 months of pretreatment , and 24.1  23.1 ru / ml during early pregnancy ( p < 0.05 ) . in the miscarriage group , 
 antiphospholipid antibody titers were 52.8  30.7 ru / ml before pretreatment , 38.5  34.2 ru / ml after pretreatment , and 33.9  24.7 ru / ml during early pregnancy ; the decrease in antiphospholipid antibodies was lower in the miscarriage group than in the live birth group ( p < 0.05 ) . 
 of the 24 infertile patients , the average antibody titer did not decline after pretreatment ( p = 0.802).conclusions : anti-2-gp1 igm was the predominant form of antibody in patients with rm and aps . 
 the decreases in antiphospholipid antibody titers correlated with better pregnancy outcomes . 
 the shorter treatment regimen was effective and economical .