Obstetric antiphospholipid syndrome: Advances in pathogenesis

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.