Antiphospholipid Syndrome and Pregnancy

What is APS?

The primary function of our immune system is to clear the infections by recognizing the foreign body and eliciting an immune response. However there are a group of diseases called autoimmune disorders in which the body recognizes its own cells and tissues and start attacking them. Antiphospholipid syndrome in pregnancy (APS) is a systemic autoimmune disorder in which antibodies are made against phospholipid binding proteins. Early diagnosis of the disease helps in preventing the complications associated with the disease.

Classification of APS

APS can  occur without the association of other autoimmune disorders (primary APS) or in  association with other rheumatic diseases (like SLE).

How to diagnose APS?

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

How APS affects pregnancy?

Antiphospholipids can affect at any stage of pregnancy.

In early stages of pregnancy (between conception and week nine of gestation), aPL affects the implantation of 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.

Other obstetric complications of the disease includes recurrent pregnancy losses, pregnancy induced hypertension, intra-uterine growth restriction.

Treatment of antiphospholipid syndrome in pregnancy

Blood thinning medications like heparin (low molecular weight), low dose aspirin and warfarin are used for treatment of APS. However, warfarin is not recommended for pregnant women since it may cause birth defects. Such 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.

 Precautions

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

·         If you test positive for aPL, you must inform your physician so that treatment can be initiated at early stages to avoid miscarriages.

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

·         During pregnancy, a woman with APS requires special care from group of doctors with multi speciality (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.

Upon early diagnosis, antiphospholipid in pregnancy can be well managed and complications be prevented.