Maternal autoantibodies and pregnancy--I: The antiphospholipid antibody syndrome

Despite the considerable interest in antiphospholipid antibodies during the last 10 years, the clinical disorders with which they are associated are still not well understood (Love and Santoro, 1990). The concept of the antiphospholipid syndrome (APS) and a means by which this can be defined (Harris, 1987) may aid us in better classifying these patients, evaluating their clinical features, and in conducting prospective studies. Standard methods for measurement of anticardiolipin antibodies (Harris et al, 1987b; Harris and the Kingston Anticardiolipin Standardization Group, 1990) and more attention to measurement of the lupus anticoagulant (Triplett and Brandt, 1988) will ultimately play an important role in improving the diagnosis of these patients. The initiation of the Kingston AntiPhospholipid Study (KAPS) group in January 1988 paves the way for future multicentre treatment trials of these patients (Harris, 1988; Triplett, 1989; Recker and Leff, 1989). For the practising physician managing a pregnant woman with the APS, there are few clear guidelines for treatment. An appropriate approach would be to assemble a multidisciplinary team for pregnancy management, exclude other causes of pregnancy loss and select the drug regimen which will cause the least harm and has some reported efficacy. Most importantly, the patient should be followed carefully throughout her pregnancy.