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Obstetric antiphospholipid syndrome: Advances in pathogenesis.

Shumin Wang1, Huimin Liu1, Wanrong Huang2

  • 1Reproductive Medical Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China.

Autoimmunity Reviews
|February 28, 2026
PubMed
Summary

The 2023 ACR-EULAR criteria refine antiphospholipid syndrome (APS) understanding, highlighting obstetric APS (OAPS) as a distinct subtype. OAPS pathogenesis involves multifactorial causes beyond thrombosis, including placental and immune dysfunction.

Keywords:
Antiphospholipid antibodiesObstetric antiphospholipid syndromePathogenesis advances

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Area of Science:

  • Rheumatology
  • Immunology
  • Obstetrics

Background:

  • The 2023 ACR-EULAR classification criteria for antiphospholipid syndrome (APS) mark a paradigm shift from a generalized approach to a subphenotype-based understanding.
  • Obstetric APS (OAPS) is now recognized as a distinct subtype with unique pathophysiology, moving beyond a singular focus on thrombosis.

Purpose of the Study:

  • To summarize the multifactorial pathogenesis of Obstetric APS (OAPS).
  • To provide a comprehensive overview facilitating research and clinical management of OAPS.

Main Methods:

  • Review of recent evidence on OAPS pathogenesis.
  • Analysis of the shift in classification criteria and its implications.

Main Results:

  • OAPS is understood as a multifactorial autoimmune disorder.
  • Pathogenesis involves trophoblast dysfunction, inflammation, and decidual microenvironmental dysfunction, in addition to placental vascular issues.

Conclusions:

  • The evolving understanding of OAPS pathogenesis is critical for advancing research and clinical practice.
  • A comprehensive summary of OAPS pathogenesis is essential for future progress.