Pregnancy Morbidity in Antiphospholipid Syndrome: What Is the Impact of Treatment?

Abstract

Women with persistently circulating antiphospholipid antibodies (aPL) have a higher incidence of recurrent abortions, fetal losses, pre-eclampsia, and placental insufficiency. Current treatment of patients with antiphospholipid syndrome (APS) during pregnancy with heparin and aspirin can act by preventing clot formation and improving live birth rates, but other obstetric morbidities remain high, especially in patients with a history of thrombotic events. In addition to the classical thrombotic placental events, other factors involving inflammation and complement activation seem to play a role in certain complications. In this article, we will review how medications interfere in the pathogenic mechanisms of APS, discuss the impact of current recommended treatment on pregnancy morbidity, and analyze new promising therapies.

Low-molecular-weight heparin and aspirin use in relation to pregnancy outcome in women with systemic lupus erythematosus and antiphospholipid syndrome: A cohort study

“…This is, amongst others, derived from studies finding a beneficial effect of aspirin in other populations at high risk for HD or intra-uterine growth (10). Furthermore, treatment with LMWH in addition to treatment with aspirin was advised for women with either primary or secondary APS in review and overview articles (7,9,17,18). In women with SLE and aPL, authors of two retrospective studies suggested that LMWH treatment during pregnancy might be beneficial to reduce maternal and perinatal pregnancy …”

Pregnancy and menopause in patients with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome: practical guide from EULAR

“…[59][60][61] Heparin is initiated after a positive pregnancy test and needs to be continued for 6 weeks postpartum. Patients with prior systemic thrombosis should receive full therapeutic doses of heparin throughout pregnancy, while those with obstetric APS-prophylactic doses.…”

Emerging Treatment Models in Rheumatology: Antiphospholipid Syndrome and Pregnancy: Pathogenesis to Translation

“…25,44 Clinical and experimental studies have produced contradictory results regarding the effectiveness of LMWH in preventing aPL-associated adverse pregnancy outcomes, and in being able to reverse the detrimental effects of aPL on trophoblast function in vitro . 66,67 Moreover, heparin promotes placental release of anti-angiogenic sFlt1. 27,68 Even with LMWH administered early in pregnancy, the incidence of late-gestation complications, such as preeclampsia, placental insufficiency, and IUGR, remains high.…”