Obstetrical antiphospholipid syndrome: from the pathogenesis to the clinical and therapeutic implications

Area of Science:

• Obstetrics and Gynecology
• Immunology
• Hematology

Background:

• Antiphospholipid syndrome (APS) is an acquired thrombophilia characterized by antiphospholipid antibodies (aPL).
• Obstetrical APS presents significant risks to both mother and fetus, including recurrent pregnancy losses, stillbirth, intrauterine growth restriction (IUGR), and preeclampsia.
• The pathogenesis involves aPL directly targeting trophoblastic cells through proapoptotic and proinflammatory pathways.

Purpose of the Study:

• To review the clinical manifestations and pathogenesis of obstetrical Antiphospholipid syndrome.
• To highlight the limitations of current first-line treatments for APS pregnancies.
• To emphasize the urgent need for novel therapeutic strategies in managing APS during pregnancy.

Main Methods:

• Literature review of obstetrical APS.
• Analysis of pathogenic mechanisms of antiphospholipid antibodies.
• Evaluation of current treatment efficacy and outcomes.

Main Results:

• Obstetrical APS is associated with severe pregnancy complications.
• Current treatments (low-dose aspirin and low-molecular weight heparin) fail in approximately 30% of cases.
• Pathogenesis involves direct attack on trophoblastic cells via immune dysregulation.

Conclusions:

• Obstetrical APS remains a complex condition with significant maternal and fetal morbidity.
• Existing therapies are inadequate for a substantial portion of APS pregnancies.
• Further research and development of new therapeutics are crucial for improving outcomes in APS pregnancies.