• Shruti GOCHHWAL

How Does Antiphospholipid Syndrome Affect Pregnancy?

Antiphospholipid syndrome in pregnancy can be dangerous, leading to recurrent miscarriages. Learn what it is, its symptoms, diagnosis, and treatment.

What is APS (Antiphospholipid Syndrome)?

Our immune system’s principal role is to clear infections, identifying the foreign body and generating an immune response. However, an autoimmune condition is known as a group where the body identifies and attacks its own cells and tissue.

Antiphospholipid syndrome (APS) is an autoimmune systemic disorder in which phospholipid binding proteins are made to antibodies. Blood clots and pregnancy complications develop from antiphospholipid antibodies.

An early identification of the condition therefore helps to reduce illness-related consequences.

How APS is classified?

how APS affects pregnancy

APS can occur without the association of other autoimmune disorders (primary APS) or in association with other rheumatic diseases (like SLE). Catastrophic Antiphospholipid Syndrome (CAPS) is a severe form of APS with multiple organ thromboses in a short period time.

How to Diagnose APS?

antiphospholipid antibody syndrome

The presence of antiphospholipid antibodies (aPL) in the blood and one relevant clinical feature indicates the antiphospholipid syndrome in pregnancy. The presence of aPL must be diagnosed on one or two occasions during pregnancy, tested at least twelve weeks apart.

aPL positivity can be categorized as

  1. Asymptomatic aPL-positive patients: These patients have no history of blood clots or pregnancy complications.

  2. APS patients with pregnancy complications only

  3. APS patients with blood clots with or without pregnancy complications.

How APS affects Pregnancy?

antiphospholipid antibody syndrome

Antiphospholipid antibodies can affect at any stage of pregnancy.

1. Miscarriages

In the early stages of pregnancy (between conception and week nine of gestation), aPL affects the implantation of the embryo, thereby inhibiting the growth of fetal cells, resulting in miscarriages. In later stages of pregnancy (between week ten of gestation and delivery), aPL can cause clots in the placenta, thereby restricting the nutrient supply to the fetus.

2. Preterm Delivery

Preterm delivery can happen as a result of preeclampsia, eclampsia, or placental insufficiency.

3. Intrauterine growth restriction- Fetus is smaller than expected.

 4. Blood clots can happen during pregnancy and up to six weeks post-pregnancy.

Antiphospholipid antibodies might not be the sole reason for the above complications. Factors like hormonal, anatomic, and genetic factors might also contribute to pregnancy complications.

What is the Treatment of APS in Pregnancy?

antiphospholipid antibody syndrome treatment

Blood-thinning medications like heparin (low molecular weight), low dose aspirin, and warfarin are used for the treatment of APS. However, warfarin is not recommended for pregnant women since it may cause birth defects. This is because blood-thinning medications interrupt the formation of blood clots.

In most cases, heparin along with aspirin is the first line of treatment to prevent further obstetrical complications.

Calcium and vitamin D supplements are also prescribed to reduce the risk of heparin-induced osteoporosis.

What Are The Precautions To Be Taken?

antiphospholipid antibody

Most pregnant women with APS deliver healthy babies. However, to have a successful pregnancy it is important to follow certain precautions.

  1. Inform your physician if aPL test comes out positive, so that treatment can be initiated at the early stages to avoid miscarriages.

  2. If there is a history of thrombotic events in the last six months, pregnancy must be considered only after a medical consultation.

  3. During pregnancy, a woman with APS requires special care from a group of doctors with multi-specialty (obstetrician, rheumatologist, and neonatologist) to avoid complications and reduce the risk of premature delivery.

Post Delivery

Most women with APS will be able to breastfeed their babies. After the delivery, patients with APS should regularly consult a rheumatologist to monitor the disease outcome.

Most patients with APS can give birth to healthy babies. Some babies are born with low birth weight. As a consequence of maternal transmission, some babies may have a PL in their blood. But, this may disappear within the first six months and do not cause blood clots.

Conclusion

Upon early diagnosis, you can manage complications caused by antiphospholipid antibody in pregnancy.

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