NICE has accredited the process used by BSR to create its clinical guidelines. The term began on 27 February 2012 and the current renewed accreditation is valid until 31 December 2023. More information on accreditation can be viewed at www.nice.org.uk/accreditation.

NICE has accredited the process used by BSR to create its clinical guidelines. The term began on 27 February 2012 and the current renewed accreditation is valid until 31 December 2023. More information on accreditation can be viewed at www.nice.org.uk/accreditation.

NICE has accredited the process used by BSR to create its clinical guidelines. The term began on 27 February 2012 and the current renewed accreditation is valid until 31 December 2023. More information on accreditation can be viewed at www.nice.org.uk/accreditation.

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Purpose of review Pregnancies in women with antiphospholipid antibodies (aPL) are associated with several pregnancy complications. The current treatment to prevent obstetric aPL-mediated morbidity is largely based on low-dose aspirin (LDA) and low-molecular-weight heparin (LMWH). Alternative treatment regimens to prevent obstetric aPL-related morbidity include the addition of the antimalarial hydroxychloroquine (HCQ). The aim of this systematic review is to identify the currently available evidence on the efficacy of HCQ to prevent aPL-related obstetric morbidity. Recent findings We identified four retrospective observational studies. No definite signal of harm was identified as none of the studies reported adverse outcomes. When comparing a total of 214 aPL-positive women with a total of 250 HCQ-exposed aPL-positive pregnancies and 521 pregnancies not exposed to HCQ, we found that HCQ exposure was not associated with an increased rate of live births [pooled OR 1.33; 95% confidence interval (CI) 0.62--2.86]). There was considerable heterogeneity in the analysis (I 2 = 59%). Summary HCQ seems well tolerated in pregnancy. However, because of the heterogeneity of available studies, the questions whether women with aPL (or some subpopulation of those) might benefit from this agent during pregnancy remains unanswered. Randomized controlled data are needed.

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Pregnancy loss is a common and devastating pregnancy complication. Recurrent early miscarriage (REM) isdefined as two or more consecutive pregnancy losses during the first trimester of pregnancy. It is a distinct entity and in approximately 50% of these patients, the underlying cause is never established. REM can be idiopathic, i.e. of unknown cause, be related to infections, anatomical or chromosomal abnormalities and can also be related to the presence of autoimmune connective tissue diseases or antiphospholipid antibodies (aPL). Hydroxychloroquine (HCQ) is an antimalarial immunomodulator and is currently being investigated for its role in the prevention of idiopathic REM and REM related to antiphospholipid antibodies (aPL). In this article we review the evidence that exists to date regarding the use of HCQ in the setting of unexplained REM and REM in relation to connective tissue diseases and aPL and antiphospholipid syndrome (APS).

BackgroundPersisting antiphospholipid antibodies (aPL) are associated with adverse obstetric events including recurrent miscarriage, late fetal loss or early delivery due to pre-eclampsia or placental insufficiency (obstetric APS) and also thrombosis. We are a tertiary referral centre for those with aPL, and have a management protocol for women with aPL during pregnancy and the puerperium with the aim of preventing obstetric complications and maternal thrombosis.ObjectivesTo report the fetal and maternal outcomes from a single centre cohort of 511 pregnancies in 372 women over a period of eight years.MethodsThis is an ongoing retrospective observational study registered as an audit. Data was collected from clinic lists attending the pregnancy clinic at the Thrombosis centre of St. Thomas’ Hospital in London, UK between Jan 2010 to December 2017. Women persistently positive for aPL were included if pregnancy outcome data was available.Results511 pregnancies in 372 women were included in the study (table 1). The overall live birth rate was 78.9%. Pregnancy outcomes are outlined in table 2.Abstract FRI0369 – Table 1DemographicsAge in years, median (range)35 (18–50) Ethnicity (white:black:asian:other:not specified)(186 (50%):17(5%):35(9%):94(25%):40(11%))Antiphospholipid antibody profile at diagnosisLupus anticoagulant, n (%) (dAPTT:DRVVT:TSVT)261 (70%) (183:144:27)Anticardiolipin IgG and IgM, n (%)119 (40%) and 144 (39%)β2-glycoprotein-I IgG and IgM, n (%)16 (4%) and 27 (7%)APS historyObstetric APS (any), n (%)125 (34%)Obstetric APS (1 st trimester loss), n (%)74 (20%)Obstetric APS (2nd trimester loss), n (%)35 (9%)Fetal death (>24 weeks), n (%)19 (5%)Intrauterine growth restriction, n (%)30 (8%)Pre-eclampsia, n (%)19 (5%)Thrombotic APS (any), n (%)106 (29%)Autoimmune profile(n=511)ANA:ENA:dsDNA, n (%)141 (39%):94 (26%):19 (5%):56 (15%)Key: ANA, antinuclear antibodies, APS, antiphospholipid syndrome; aPL, antiphospholipid antibodies; aAPPT, dilute Activated Partial Thromboplastin Time; dRVVT, dilute Russel Viper Venom Time; dsDNA, doublestranded DNA, ENA, Extractable nuclear antigens, TSVT, Taipan Snake Venom TimeAbstract FRI0369 – Table 2Pregnancy outcomesConclusionsThese results from the largest single centre cohort reported show that using our management protocol, nearly 80% of women with aPL had a successful pregnancy outcome.Disclosure of InterestNone declared