Antiphospholipid Syndrome and Pregnancy

Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by an increased risk of venous and arterial thrombosis and pregnancy-related complications in the presence of antiphospholipid antibodies (aPL). Obstetric APS is a possible cause of recurrent early miscarriages and late foetal losses, particularly in the second and third trimesters. Other complications include pre-eclampsia, intrauterine growth restriction, and stillbirth. The pathogenic mechanisms include aPL-induced thrombophilia, endothelial dysfunction, and complement activation, causing a significant impairment of the placental development and function. Management of obstetric APS aims at improving pregnancy outcomes and reducing the maternal thrombotic risks. The treatment should be personalized according to the patient’s clinical history and risk stratification; it is usually based on a combination of low-dose aspirin and prophylactic/therapeutic low molecular weight heparin throughout pregnancy and postpartum. For women with refractory APS, adjunctive treatments could be evaluated. Close monitoring of foetal growth and maternal health is crucial. With appropriate treatment and multidisciplinary care, a majority of women with APS can have successful pregnancies, although the risk of poor obstetric outcome remains higher than in the general population.