Antiphospholipid Syndrome and Pre-Eclampsia

Abstract

Antiphospholipid syndrome (APS) is defined as an autoimmune disorder characterized by recurrent thrombosis or obstetrical morbidity. These features are linked to the presence in blood of autoantibodies against negatively charged phospholipids or phospholipid-binding proteins. Obstetric morbidity includes recurrent abortion (early and late) and severe pre-eclampsia (P-EC)/hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and/or severe placental insufficiency. Criteria that define the major clinical and laboratory events were published in revised forms in the Sydney recommendations in 2006. We analyzed the blood of patients with severe P-EC according to the subgroups based on the 2006 revised criteria definition and compared these results with women after uncomplicated pregnancy and delivery. We found 20% elevated antiphospholipid antibodies (APAs) in women with severe P-EC (group I, 7.5%; group IIa, 5.0%; group IIb, 5.0%; group IIc, 2.5%). The increased APAs were observed only in women with severe P-EC (odds ratio: 2.45; 95% confidence interval, 1.01 to 4.3) and not in patients with severe P-EC at >34 weeks of gestation. According to our retrospective observation, we recommend the determination of anticardiolipin antibodies, lupus anticoagulant, and β-2 glycoprotein-1 antibodies in patients with severe P-EC at <34 weeks of gestation.

Autoimmune connective tissue diseases

“…PET has been reported to occur in about one-third of patients with APS, often with early onset before 34 weeks of gestation [49]. The risk of HELLP is increased in APS with a frequency of 0.66e10.6% reported, and often manifesting in the second trimester [50,51].…”

Pravastatin improves pregnancy outcomes in obstetric antiphospholipid syndrome refractory to antithrombotic therapy

“…PE and intrauterine growth restriction (IUGR) -associated with impaired placentation -are obstetric complications frequently observed in APS (9)(10)(11)(12). Both conditions are major causes of maternal and fetal morbidity worldwide, with uncertain prevention and management (13,14).…”

Signs of eclampsia during singleton deliveries and early neonatal mortality in low‐ and middle‐income countries from three WHO regions

“…In the present study, the analyses were adjusted for socioeconomic and demographic variables, prenatal and delivery care received, as well as signs of infection, which have been identified as linked with both early neonatal mortality and eclampsia; however, it was not possible to consider further potential confounding factors such as pre‐existing hypertension, chronic kidney disease, diabetes mellitus (type 1 and type 2), and certain autoimmune diseases including antiphospholipid syndrome and systemic lupus erythematosus . Although it could not be ascertained whether convulsions were due to epilepsy, their prevalence in pregnant women is reported to be approximately 0.5% and 90% of pregnancies in patients with chronic neurological disorders proceed without adverse events .…”