Therapeutic Interventions for Obstetric Antiphospholipid Syndrome Associated with Recurrent Pregnancy Loss: A Scoping...

Antiphospholipid syndrome (APS) is an autoimmune disease defined by thrombotic or obstetrical clinical manifestations and the persistent presence of antiphospholipid antibodies, including lupus anticoagulant, anticardiolipin antibodies, and anti-β2-glycoprotein I antibodies. Obstetric APS (OAPS) is associated with pregnancy morbidity, including early recurrent pregnancy loss (RPL), preeclampsia, premature birth, and stillbirth. Treatment regimens for women with OAPS are designed to optimize pregnancy outcomes. It is still debated which intervention results in the most optimal pregnancy outcome. This scoping review examines treatment options for women with OAPS presenting with RPL based solely on randomized controlled trials (RCTs) reporting pregnancy outcomes. A systematic search identified 1,234 studies published up to January 2026, from which 14 RCTs met the inclusion criteria: pregnant women with APS defined as persistent aPL positivity and RPL (≥2) receiving therapeutic intervention with live birth as the primary outcome. These RCTs, published between 1992 and 2017, included 1,878 participants. Secondary outcomes, including birth weight, preeclampsia, preterm delivery, and bleeding, were also analyzed. Different treatment options such as low-dose aspirin (LDA), unfractionated heparin, low molecular weight heparin (LMWH), corticosteroids, and intravenous immunoglobulin were used in the clinical trials. Antithrombotic therapy (LDA + LMWH) was associated with higher live birth rates compared with the other evaluated strategies. However, this finding is based on a small number of heterogeneous RCTs and is disproportionately driven by a single large trial. Consequently, substantial uncertainty remains. High-quality, adequately powered RCTs are urgently needed to provide robust evidence for optimal OAPS management.