Pregnancy Complications and Therapy in Women with Antiphospholipid Syndrome (APS)

Special Issue - Antiphospholipid Syndrome

Austin J Clin Immunol. 2024; 10(1): 1061.

Pregnancy Complications and Therapy in Women with Antiphospholipid Syndrome (APS)

Ilias Pessach¹*; Emmanouil Kalampokas²; Theodoros Kalampokas³

¹Hematology Dept, Athens Medical Center, Athens, Greece

²Unit of Gynecologic Oncology, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

³Unit of Obstetrics and Gynecology, Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

*Corresponding author: Ilias Pessach Hematology Dept, Athens Medical Center, Athens, Greece. Email: iliaspessach1980@gmail.com

Received: December 01, 2023 Accepted: January 08, 2024 Published: January 15, 2024

Abstract

Women with antiphospholipid antibodies are at risk of unsuccessful pregnancy outcome, which may include many features such as preeclampsia, premature delivery, intrauterine growth restriction. The risk of thrombosis is higher during the third semester. The standard care in obstetric antiphospholipid syndrome includes aspirin and heparin, which have improved live births significantly, however one small percentage continue to have pregnancy complications. There are many new treatment approaches, but more randomized clinical trials are needed to assess the efficacy and safety. This review aims to highlight the risk factors associating the anti-antiphospholipid antibodies in pregnancy, as well the most severe form which is the catastrophic anti-phospholipid syndrome, and therapies currently available, but future directions through personalized new treatments for different aPL profiles, especially high-risk women with comorbidities. Novel promising drugs, with no complications, according to few case reports, are being identified, but we need time to evaluate the results.

Keywords: Antiphospholipid antibodies (aPL); Antiphospholipid syndrome (APS); Catastrophic anti-phospholipid syndrome (CAPS); Autoimmune disease; Pregnancy morbidity

Introduction

Antiphospholipid Syndrome (APS) is an autoimmune disorder characterized by the presence of heterogeneous antiphospholipid antibodies [aPL: Lupus Anticoagulants (LA), Anticardiolipin antibodies (aCL), antibodies against β2-glycoprotein-I (anti-β2GPI]. APS may be a contributory factor in 6.1% of cases of pregnancy morbidity [1]. Anti-β2GPIs are often referred as an important cause of APS. The phospholipid-binding β2-glycoprotein I (β2GPI) is the main autoantigen in APS. In fact, IgG antibodies targeting β2GPI (ab2GPI) is directly involved in thrombosis and pregnancy morbidity in several mouse models [2]. aPL can create a thrombogenic environment through several mechanisms involving various cell lines and clotting factors. One mechanism can be enhancing the production of Tissue Factor (TF) by activated monocytes and endothelial cells. Interference with natural regulators such as protein C, antithrombin, and tissue plasminogen activator, increases the production of von Willebrand factor by endothelial cells, and promotes platelet activation. Platelets have dynamic role in arterial thrombosis, and in APS specifically (Figure 1) [3]. Antibodies reacting with β2 glycoprotein I (β2GPI) bind to the surface of stimulated platelets triggering platelet activation [4], which can lead to the endothelium activation, thus following the fibrin generation, making platelet activation a primary mechanism of aPL-mediated arterial thrombosis [5]. Clinical manifestations of APS include thrombosis, obstetrical complications, but there are also the “noncriteria” manifestations [6], which includes thrombocytopenia and many other features, making the APS pathology understanding and therapy investigation very challenging, especially in pregnancy.

Citation: Pessach I, Kalampokas E, Kalampokas T. Pregnancy Complications and Therapy in Women with Antiphospholipid Syndrome (APS). Austin J Clin Immunol. 2024; 10(1): 1061.