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Obstetric antiphospholipid syndrome carries an increased lifetime risk for obstetric and thrombotic complications-a
Ariel Katherine Rhein1, Anat Rabinovich2, Ran Abuhasira1,3
1The Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
Obstetric Antiphospholipid Syndrome (OAPS) patients face higher risks of thrombotic events and pregnancy complications, even with treatment. Thrombotic APS (TAPS) patients also show increased preeclampsia risk. Further research is needed for optimal patient management.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Reproductive Immunology
Background:
- Antiphospholipid syndrome (APS) presents as either thrombotic APS (TAPS) or obstetric APS (OAPS), with limited data on long-term complications.
- Understanding the distinct risks associated with OAPS and TAPS is crucial for patient care.
Purpose of the Study:
- To compare obstetric history, antiphospholipid antibody profiles, complications, and pregnancy outcomes between TAPS and OAPS phenotypes.
- To evaluate the risks of thrombotic and obstetric complications in OAPS and TAPS patients compared to the general obstetric population.
Main Methods:
- Retrospective cohort study of 116,409 women delivering singleton pregnancies between 1998 and 2020.
- Included 71 APS patients (49 OAPS, 22 TAPS), comparing their outcomes with the general obstetric population.
- Analyzed demographics, obstetric, neonatal, and thrombotic outcomes.
Main Results:
- OAPS patients had a significantly increased risk of thrombotic events (OR 18.0) compared to the general population.
- Despite antithrombotic treatment, OAPS patients showed elevated risks for placenta-related and neonatal complications, including late fetal loss, stillbirth, placental abruption, preeclampsia, FGR, SGA, and low Apgar scores.
- TAPS patients had an increased risk of preeclampsia (aOR 3.1).
Conclusions:
- OAPS patients exhibit a heightened risk of thrombotic events and obstetric complications, even with standard treatment.
- TAPS patients also face increased obstetric risks, particularly preeclampsia.
- Findings underscore the need for careful management strategies for APS patients and validation in prospective studies.
Background:
Antiphospholipid syndrome (APS) can present with either a thromboembolic event (thrombotic APS, TAPS) or an obstetric complication (obstetric APS, OAPS). Data on long-term complications in the different APS phenotypes are limited.
Objectives:
We aimed to compare obstetric history, antiphospholipid antibody profiles, obstetric and thromboembolic complications, and pregnancy outcomes between TAPS and OAPS.
Methods:
This retrospective cohort study included women who delivered singleton pregnancies between 1998 and 2020. One hundred sixteen thousand four hundred nine women were included, resulting in 320,455 deliveries. Among the included patients, 71 were diagnosed with APS, 49 were classified as OAPS, and 22 as TAPS. The demographics, obstetric, neonatal, and thrombotic outcomes were compared among TAPS, OAPS, and the general obstetric population.
Results:
OAPS patients had an increased risk of thrombotic events compared with the general obstetric population (odds ratio [OR] 18.0; 95% CI, 8.7-37.2). In pregnancies following the diagnosis of APS, despite standard antithrombotic treatment, OAPS patients exhibited an elevated risk of placenta-related and neonatal complications compared with the general obstetric population (late fetal loss [adjusted OR {aOR}, 15.3; 95% CI, 0.5-27.5], stillbirth [aOR, 5.9; 95% CI, 2.2-15.4], placental abruption [aOR, 4.8; 95% CI, 1.5-15.3], preeclampsia [aOR, 4.4; 95% CI, 2.5-7.7], fetal growth restriction [aOR, 4.3; 95% CI, 8.5-27.5], small for gestational age neonate [aOR, 4.0; 95% CI, 2.4-6.6], and low Apgar scores [Apgar'1: aOR, 2.6; 95% CI, 1.3-10.4; Apgar'5: aOR, 3.7; 95% CI, 1.3-10.4]). TAPS patients exhibited increased risk of preeclampsia (aOR, 3.1; 95% CI, 1.2-8).
Conclusion:
OAPS patients exhibit a heightened risk of thrombotic events compared with the general obstetric population. Despite treatment, OAPS and TAPS still presented obstetric complications. These findings, after confirmation in prospective studies, need to be taken into consideration when planning the treatment approach for these patients.
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