Strategies for Addressing Recurrent Pregnancy Loss (Virtual Symposium)-06-Lockwood-Anticardiolipin Syndrome

06-Lockwood-Anticardiolipin Syndrome

Pdf Summary

The Antiphospholipid Syndrome (APS) in pregnancy is characterized by the presence of antiphospholipid antibodies (APA), including lupus anticoagulants (LAC), anticardiolipin antibodies (ACA), and anti-β2 glycoprotein-1 (anti-β2GP1). These antibodies target proteins bound to negatively charged phospholipids on cell membranes, promoting thrombosis, microvascular disease, thrombocytopenia, and adverse pregnancy outcomes (APOs) such as recurrent pregnancy loss (RPL), stillbirth, and preeclampsia.<br /><br />Pathogenesis involves APA interfering with natural anticoagulant mechanisms (e.g., Protein C, antithrombin III), enhancing platelet aggregation, increasing endothelial tissue factor expression, and triggering complement activation. APA also reduces annexin V on placental trophoblasts, exposing prothrombotic surfaces and leading to placental insufficiency.<br /><br />Diagnosis relies on clinical history—including unexplained stillbirths, recurrent fetal losses, severe preeclampsia, intrauterine growth restriction (IUGR), thrombosis, or autoimmune disorders—combined with laboratory evidence of persistent APA positivity determined by internationally accepted criteria (ACR/EULAR 2023). Classification requires scoring clinical and laboratory domains, achieving at least 3 points each.<br /><br />APS is found in 5-20% of RPL patients depending on criteria, with higher association to late fetal losses. APS is linked to other autoimmune diseases like systemic lupus erythematosus (SLE), infections, and certain medications.<br /><br />Treatment during pregnancy primarily includes low-molecular-weight heparin (LMWH) plus low-dose aspirin, achieving about 80% live birth rates but with increased risk of pregnancy complications. Refractory cases may require adjunctive therapies such as corticosteroids, hydroxychloroquine (shown in meta-analyses to improve outcomes), or intravenous immunoglobulin, although data remain limited.<br /><br />In summary, APS is a significant cause of thrombosis and pregnancy morbidity. Early diagnosis and tailored anticoagulant treatment improve live birth rates but require ongoing management to mitigate complications.

Keywords

Antiphospholipid Syndrome

Pregnancy

Antiphospholipid Antibodies

Lupus Anticoagulants

Recurrent Pregnancy Loss

Thrombosis

Preeclampsia

Low-Molecular-Weight Heparin

Hydroxychloroquine

Placental Insufficiency