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Updated: Jan 20, 2026
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Triple Antiphospholipid (aPL) Antibodies Positivity Is Associated With Pregnancy Complications in aPL Carriers: A
Maria-Grazia Lazzaroni1,2, Micaela Fredi1,2, Laura Andreoli1,2
1Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Insights
Pregnant women with antiphospholipid antibodies (aPL) face risks for thrombosis and adverse pregnancy outcomes (APO). Triple aPL positivity significantly increases APO risk, even with standard treatment, suggesting a need for new strategies.
Area of Science:
- Obstetrics and Gynecology
- Rheumatology
- Immunology
Background:
- Antiphospholipid antibodies (aPL) are linked to thrombosis and adverse pregnancy outcomes (APO).
- Management strategies for pregnant individuals with aPL but without Antiphospholipid Syndrome (APS) criteria remain unclear.
- Risk stratification is crucial for pregnant aPL carriers.
Purpose of the Study:
- To retrospectively evaluate pregnancy outcomes in aPL carriers.
- To identify factors associated with adverse pregnancy outcomes (APO) and maternal complications in pregnant aPL carriers.
- To assess the efficacy of current treatments in this population.
Main Methods:
- Retrospective evaluation of medical records from 62 pregnant aPL carriers across three Rheumatology centers (1994-2015).
- Exclusion of patients with autoimmune diseases or other causes of pregnancy complications.
- Univariate and multivariate analyses to identify associated factors for pregnancy complications.
Main Results:
- 8 out of 62 (12.9%) pregnant aPL carriers experienced an aPL-related event (2 thrombosis, 6 APO).
- Triple aPL positivity was significantly associated with increased pregnancy complications (p:0.001 univariate, p:0.01 multivariate, OR 21.3).
- Combined low-dose aspirin (LDA) and low molecular weight heparin (LMWH) did not prevent APO in triple aPL positive cases.
Conclusions:
- Risk stratification based on immunologic (triple aPL profile) and non-immunologic features is essential for pregnant aPL carriers.
- Standard treatment with LDA and LMWH may be insufficient for preventing APO in triple aPL positive individuals.
- Pregnant women with triple aPL positivity might require alternative or additional therapeutic strategies.
Abstract:
Objective: Antiphospholipid antibodies (aPL) are risk factors for thrombosis and adverse pregnancy outcomes (APO). The management of the so called "aPL carriers" (subjects with aPL positivity without the clinical criteria manifestations of APS) is still undefined. This study aims at retrospectively evaluating the outcomes and the factors associated with APO and maternal complications in 62 pregnant aPL carriers. Methods: Medical records of pregnant women regularly attending the Pregnancy Clinic of 3 Rheumatology centers from January 1994 to December 2015 were retrospectively evaluated. Patients with concomitant autoimmune diseases or other causes of pregnancy complications were excluded. Results: An aPL-related event was recorded in 8 out of 62 patients (12.9%) during pregnancy: 2 thrombosis and 6 APO. At univariate analysis, factors associated with pregnancy complications were acquired risk factors (p:0.008), non-criteria aPL manifestations (p:0.024), lupus-like manifestations (p:0.013), and triple positive aPL profile (p:0.001). At multivariate analysis, only the association with a triple aPL profile was confirmed (p:0.01, OR 21.3, CI 95% 1.84-247). Patients with triple aPL positivity had a higher rate of pregnancy complications, despite they were more frequently receiving combined treatment of low dose aspirin (LDA) and low molecular weight heparin (LMWH) at prophylactic dose. Conclusion: This study highlights the importance of risk stratification in pregnant aPL carriers, in terms of both immunologic and non-immunologic features. Combination treatment with LDA and LMWH did not prevent APO in some cases, especially in carriers of triple aPL positivity. Triple positive aPL carriers may deserve additional therapeutic strategies during pregnancy.
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