ANTIPHOSPHOLIPID SYNDROME (D ERKAN, SECTION EDITOR)

Current Rheumatology Reports

, 16:403

First online:

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

  • Guilherme R. de JesúsAffiliated withDepartment of Obstetrics, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro Email author 
  • , Gustavo RodriguesAffiliated withDepartment of Obstetrics, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro
  • , Nilson R. de JesúsAffiliated withDepartment of Obstetrics, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro
  • , Roger A. LevyAffiliated withDepartment of Rheumatology, Faculdade de Ciências Médicas, Universidade do Estado do Rio de JaneiroFederico Foundation

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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.

Keywords

Antiphospholipid syndrome APS Obstetric APS Obstetric antiphospholipid syndrome Pre-eclampsia Intrauterine growth restriction Prematurity Treatment Abortion Pregnancy loss Fetal death Heparin Aspirin Complement activation Thrombosis Hydroxychloroquine Eculizumab