Pregnancy Management in Women with Antiphospholidic Syndrome

The antiphospholipid syndrome (APS or Hughes Syndrome) is a systemic autoimmune disease characterised by the presence of specific and persistent circulating antiphospholipid antibodies (APL) and the subsequent morbidities they cause, including pregnancy complications and thrombosis. The three main antiphospholipid antibodies are: lupus anticoagulant (LA); anticardiolipin antibodies (aCL) IgG and IgM; and anti-â2-glycoprotein 1 IgG and IgM antibodies. Antiphospholipid syndrome is associated with pregnancy complications such as recurrent early fetal loss, fetal death, preeclampsia (PE), and fetal growth restriction (FGR). Although autoimmune disorders may have serious implication during pregnancy important advancements in pregnancy outcome have been reported in women with APL. The challenge arises in case of women refractory to conventional treatment (heparine/aspirin combination), which occurs in about 20-30% of cases. The management of pregnant women with non-criteria APS manifestations and that of APL carriers during their first pregnancy is also discussed. This paper aims to discuss the risk stratification, clinical and pregnancy implications and current treatment strategies for pregnant women.