Antiphospholipid Syndrome and Pregnancy
DOI:
https://doi.org/10.12775/JEHS.2023.15.01.002Keywords
antiphospholipid syndrome, obstretical complications, antiphospholipid antibodies, thrombosis, pregnancyAbstract
Antiphospholipid syndrome is an autoimmune disease with a wide spectrum of manifestations from different organs, therefore it is challenging to diagnose. The disease presents antiphospholipid antibodies such as anticardiolipin antibodies (aCL), lupus anticoagulant (LA) and antiβ2-glycoprotein 1 antibodies (β2GPI). The most common symptoms include thrombosis in veins and arteries and obstretical complications such as early miscarriage, intrauterine fetal death, intrauterine growth restriction (IUGR), placental insufficiency, premature labor and eclampsia. To diagnose a patient with APS certain criteria have been chosen, where at least one clinical and one laboratory criterion must be present. In many cases it takes a lot of time before a proper diagnosis has been made, when a female patient presents obstretical complications. Adequate pharmacological treatment increases the odds of live birth rate from 20-30% to 70-80%. Scientific research shows correlation between antiphospholipid syndrome, infertility and premature ovarian insufficiency. Treatment mostly consists of heparin and low-dose aspirin, in certain cases hydrochloroquine is prescribed. Aside from pharamcological therapy, it is very important to minimize the effects of modifiable risk factors. The following article focuses on complications, diagnosing and therapy in pregnant women suffering from Antiphospholipid syndrome. All sources can be found in Pubmed’s website database.
References
Schreiber K, Hunt BJ. Managing antiphospholipid syndrome in pregnancy. Thromb Res. 2019 Sep;181 Suppl 1:S41-S46. doi: 10.1016/S0049-3848(19)30366-4. PMID: 31477227.
Duarte-García A, Pham MM, Crowson CS, Amin S, Moder KG, Pruthi RK, Warrington KJ, Matteson EL. The Epidemiology of Antiphospholipid Syndrome: A Population-Based Study. Arthritis Rheumatol. 2019 Sep;71(9):1545-1552. doi: 10.1002/art.40901. Epub 2019 Aug 1. Erratum in: Arthritis Rheumatol. 2020 Apr;72(4):597. PMID: 30957430; PMCID: PMC6717037.
Czwalinna A, Bergmann F. Prevention of Pregnancy Complications in Antiphospholipid Syndrome. Hamostaseologie. 2020 Jun;40(2):174-183. doi: 10.1055/a-1113-0689. Epub 2020 May 26. PMID: 32455458.
Yang J, Liang M. Risk factors for pregnancy morbidity in women with antiphospholipid syndrome. J Reprod Immunol. 2021 Jun;145:103315. doi: 10.1016/j.jri.2021.103315. Epub 2021 Mar 29. PMID: 33845396.
Pignatelli P, Ettorre E, Menichelli D, Pani A, Violi F, Pastori D. Seronegative antiphospholipid syndrome: refining the value of "non-criteria" antibodies for diagnosis and clinical management. Haematologica. 2020 Mar;105(3):562-572. doi: 10.3324/haematol.2019.221945. Epub 2020 Jan 30. PMID: 32001534; PMCID: PMC7049333.
Leal Rato M, Bandeira M, Romão VC, Aguiar de Sousa D. Neurologic Manifestations of the Antiphospholipid Syndrome - an Update. Curr Neurol Neurosci Rep. 2021 Jun 14;21(8):41. doi: 10.1007/s11910-021-01124-z. PMID: 34125304; PMCID: PMC8200381.
Carmi O, Berla M, Shoenfeld Y, Levy Y. Diagnosis and management of catastrophic antiphospholipid syndrome. Expert Rev Hematol. 2017 Apr;10(4):365-374. doi: 10.1080/17474086.2017.1300522. Epub 2017 Mar 13. PMID: 28277850.
Cervera R, Rodríguez-Pintó I, Espinosa G. The diagnosis and clinical management of the catastrophic antiphospholipid syndrome: A comprehensive review. J Autoimmun. 2018 Aug;92:1-11. doi: 10.1016/j.jaut.2018.05.007. Epub 2018 May 18. PMID: 29779928.
Negrini S, Pappalardo F, Murdaca G, Indiveri F, Puppo F. The antiphospholipid syndrome: from pathophysiology to treatment. Clin Exp Med. 2017 Aug;17(3):257-267. doi: 10.1007/s10238-016-0430-5. Epub 2016 Jun 22. PMID: 27334977.
Dobrowolski C, Erkan D. Treatment of antiphospholipid syndrome beyond anticoagulation. Clin Immunol. 2019 Sep;206:53-62. doi: 10.1016/j.clim.2018.03.001. Epub 2018 Mar 3. PMID: 29510235.
Pierangeli SS, Erkan D. Antiphospholipid syndrome treatment beyond anticoagulation: are we there yet? Lupus. 2010 Apr;19(4):475-85. doi: 10.1177/0961203310361489. PMID: 20353991.
Espinosa G, Cervera R. Current treatment of antiphospholipid syndrome: lights and shadows. Nat Rev Rheumatol. 2015 Oct;11(10):586-96. doi: 10.1038/nrrheum.2015.88. Epub 2015 Jun 30. PMID: 26122952.
Castro-Gutierrez A, Young K, Bermas BL. Pregnancy and Management in Women with Rheumatoid Arthritis, Systemic Lupus Erythematosus, and Obstetric Antiphospholipid Syndrome. Rheum Dis Clin North Am. 2022 May;48(2):523-535. doi: 10.1016/j.rdc.2022.02.009. PMID: 35400376.
Sayar Z, Moll R, Isenberg D, Cohen H. Thrombotic antiphospholipid syndrome: A practical guide to diagnosis and management. Thromb Res. 2021 Feb;198:213-221. doi: 10.1016/j.thromres.2020.10.010. Epub 2020 Oct 15. PMID: 33485122; PMCID: PMC7560059.
Sacharidou A, Shaul PW, Mineo C. New Insights in the Pathophysiology of Antiphospholipid Syndrome. Semin Thromb Hemost. 2018 Jul;44(5):475-482. doi: 10.1055/s-0036-1597286. Epub 2017 Jan 27. PMID: 28129662; PMCID: PMC6333209.
Rodrigues VO, Soligo AGES, Pannain GD. Antiphospholipid Antibody Syndrome and Infertility. Rev Bras Ginecol Obstet. 2019 Oct;41(10):621-627. English. doi: 10.1055/s-0039-1697982. Epub 2019 Oct 28. PMID: 31658490.
Blank M, Shoenfeld Y. Antiphospholipid antibody-mediated reproductive failure in antiphospholipid syndrome. Clin Rev Allergy Immunol. 2010 Apr;38(2-3):141-7. doi: 10.1007/s12016-009-8146-x. PMID: 19562524.
Hoayek JG, Moussa HN, Rehman HA, Nasab SH, Blackwell SC, Sibai BM. Catastrophic antiphospholipid syndrome in pregnancy, a diagnosis that should not be missed. J Matern Fetal Neonatal Med. 2016 Dec;29(24):3950-5. doi: 10.3109/14767058.2016.1160047. Epub 2016 Mar 29. PMID: 27023104.
Sciascia S, Lopez-Pedrera C, Roccatello D, Cuadrado MJ. Catastrophic antiphospholipid syndrome (CAPS). Best Pract Res Clin Rheumatol. 2012 Aug;26(4):535-41. doi: 10.1016/j.berh.2012.07.005. PMID: 23040365.
Gómez-Puerta JA, Sanin-Blair J, Galarza-Maldonado C. Pregnancy and catastrophic antiphospholipid syndrome. Clin Rev Allergy Immunol. 2009 Jun;36(2-3):85-90. doi: 10.1007/s12016-008-8100-3. PMID: 19052924.
Arslan E, Branch DW. Antiphospholipid syndrome: Diagnosis and management in the obstetric patient. Best Pract Res Clin Obstet Gynaecol. 2020 Apr;64:31-40. doi: 10.1016/j.bpobgyn.2019.10.001. Epub 2019 Oct 17. PMID: 31704207.
Cohen D, Berger SP, Steup-Beekman GM, Bloemenkamp KW, Bajema IM. Diagnosis and management of the antiphospholipid syndrome. BMJ. 2010 May 14;340:c2541. doi: 10.1136/bmj.c2541. PMID: 20472677.
Taraborelli M, Andreoli L, Tincani A. Much more than thrombosis and pregnancy loss: the antiphospholipid syndrome as a 'systemic disease'. Best Pract Res Clin Rheumatol. 2012 Feb;26(1):79-90. doi: 10.1016/j.berh.2012.01.006. PMID: 22424195.
Fischer-Betz R, Specker C. Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. Best Pract Res Clin Rheumatol. 2017 Jun;31(3):397-414. doi: 10.1016/j.berh.2017.09.011. Epub 2017 Oct 11. PMID: 29224680.
Kiss E, Bhattoa HP, Bettembuk P, Balogh A, Szegedi G. Pregnancy in women with systemic lupus erythematosus. Eur J Obstet Gynecol Reprod Biol. 2002 Mar 10;101(2):129-34. doi: 10.1016/s0301-2115(01)00525-5. PMID: 11858886.
Graf J. Central Nervous System Manifestations of Antiphospholipid Syndrome. Rheum Dis Clin North Am. 2017 Nov;43(4):547-560. doi: 10.1016/j.rdc.2017.06.004. PMID: 29061241.
Sciascia S, Cuadrado MJ, Khamashta M, Roccatello D. Renal involvement in antiphospholipid syndrome. Nat Rev Nephrol. 2014 May;10(5):279-89. doi: 10.1038/nrneph.2014.38. Epub 2014 Mar 18. PMID: 24642799.
Uthman I, Godeau B, Taher A, Khamashta M. The hematologic manifestations of the antiphospholipid syndrome. Blood Rev. 2008 Jul;22(4):187-94. doi: 10.1016/j.blre.2008.03.005. Epub 2008 Apr 15. PMID: 18417261.
Noureldine MH, Khamashta MA, Merashli M, Sabbouh T, Hughes GR, Uthman I. Musculoskeletal manifestations of the antiphospholipid syndrome. Lupus. 2016 Apr;25(5):451-62. doi: 10.1177/0961203316636467. Epub 2016 Feb 27. PMID: 26923284.
Cohen H, Efthymiou M, Devreese KMJ. Monitoring of anticoagulation in thrombotic antiphospholipid syndrome. J Thromb Haemost. 2021 Apr;19(4):892-908. doi: 10.1111/jth.15217. Epub 2021 Feb 20. PMID: 33325604.
Pengo V, Bison E, Denas G, Jose SP, Zoppellaro G, Banzato A. Laboratory Diagnostics of Antiphospholipid Syndrome. Semin Thromb Hemost. 2018 Jul;44(5):439-444. doi: 10.1055/s-0037-1601331. Epub 2017 May 3. PMID: 28470652.
Cervera R, Conti F, Doria A, Iaccarino L, Valesini G. Does seronegative antiphospholipid syndrome really exist? Autoimmun Rev. 2012 Jun;11(8):581-4. doi: 10.1016/j.autrev.2011.10.017. Epub 2011 Oct 22. PMID: 22036830.
Pengo V, Banzato A, Bison E, Denas G, Zoppellaro G, Bracco A, Padayattil Jose S, Hoxha A, Ruffatti A. Laboratory testing for antiphospholipid syndrome. Int J Lab Hematol. 2016 May;38 Suppl 1:27-31. doi: 10.1111/ijlh.12507. Epub 2016 May 9. PMID: 27161602.
Meroni PL, Borghi MO, Raschi E, Tedesco F. Pathogenesis of antiphospholipid syndrome: understanding the antibodies. Nat Rev Rheumatol. 2011 Jun;7(6):330-9. doi: 10.1038/nrrheum.2011.52. Epub 2011 May 10. PMID: 21556027.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Ewa Grabowska, Weronika Pawłocik, Weronika Pawlak, Laura Wojtala, Julia Szymańska, Kamil Kapłon, Agnieszka Możdżyńska, Lena Musiał, Anna Rymarz, Izabela Kamińska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 594
Number of citations: 0