[Antiphospholipid syndrome and preeclampsia]

Preeclampsia is defined as gestational hypertension plus proteinuria (≥ 300 mg/day). It is a common disorder during pregnancy, accounting for about 20% of fetal mortality occurring after the 20th week of gestation. Preeclampsia is considered severe when it involves severe gestational hypertension and/or proteinuria ≥ 5 g/day, or when it is associated with pulmonary edema, oliguria, thrombocytopenia, elevation of liver enzymes, or involvement of the central nervous system. Antiphospholipid antibody syndrome (APS) is at present considered one of the predisposing conditions for the occurrence of severe preeclampsia. This review provides an update of the best available treatments to prevent the evolution of APS towards severe preeclampsia. The proposed pharmacological approach, based on the use of low-dose salicylate alone or combined with low molecular-weight heparin, is titrated against different subsets of clinical and laboratory data. Thorough treatment and close surveillance of patients suffering from APS during pregnancy requires the expertise of a joint team consisting of gynecologists, neonatal doctors, nephrologists, anesthesiologists, and rheumatologists.