Antiphospholipid syndrome and pregnancy

Satta, Rosanna; Biondi, Gabriele

doi:10.23736/s0392-0488.18.06152-7

Cited by 9 publications

(7 citation statements)

References 12 publications

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“…Antiphospholipid syndrome (APS) is a rare heterogenous autoimmune disorder which is associated with severe life-threatening complications during pregnancy. [1] This disease affects a minority of women, and is associated with maternal and fetal complications such as miscarriage, eclampsia, fetal intrauterine growth retardation, preterm delivery, and neonatal mortality. [2]…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in patients with primary antiphospholipid syndrome

Liu

Sun

2019

Medicine

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Background: Antiphospholipid syndrome (APS) is a rare heterogenous autoimmune disorder with severe life-threatening complications shown during pregnancy. In this analysis, we aimed to systematically compare the pregnancy outcomes (both maternal and fetal) in patients with APS. Methods: Web of Science, Google Scholar, Medicus, Cochrane Central, Embase, and Medline were searched for relevant English publications. The main inclusion criteria were based on studies that compared pregnancy outcomes in patients with APS vs a control group. Statistical analysis was carried out by the RevMan software version 5.3. This analysis involved dichotomous data, and risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the analysis. Results: Eight studies consisting of a total number of 212,954 participants were included. Seven hundred seventy participants were pregnant women with APS and 212,184 participants were assigned to the control group. Pregnancy-induced hypertension was significantly higher in women with APS (RR: 1.81, 95% CI: 1.33 – 2.45; P = .0002). The risks of fetal loss (RR: 1.33, 95% CI: 1.00–1.76; P = .05), abortion (RR: 2.42, 95% CI: 1.46–4.01; P = .0006), thrombosis (RR: 2.83, 95% CI: 1.47–5.44; P = .002), and preterm delivery (RR: 1.89, 95% CI: 1.52–2.35; P = .00001) were also significantly higher in women with APS. However, placental abruption (RR: 1.35, 95% CI: 0.78–2.34; P = .29) and pulmonary embolism were not significantly different (RR: 1.47, 95% CI: 0.11–19.20; P = .77). The risk of neonatal mortality (RR: 3.95, 95% CI: 1.98–7.86; P = .0001), infants small for gestational age (RR: 1.38, 95% CI: 1.04–1.82; P = .02), premature infants (RR: 1.86, 95% CI: 1.52–2.28; P = .0001), and infants who were admitted to neonatal intensive care unit (RR: 3.35, 95% CI: 2.29–4.89; P = .00001) were also significantly higher in women with APS. Conclusion: This analysis showed APS to be associated with significantly worse pregnancy outcomes when compared to the control group. A significantly higher risk of maternal and fetal complications was observed in this category of patients. Therefore, intense care should be given to pregnant women with APS to monitor unwanted outcomes and allow a successful pregnancy.

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Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in patients with primary antiphospholipid syndrome

Liu

Sun

2019

Medicine

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“…LMWHs can reduce the risk of pregnancy complications, including unexplained recurrent pregnancy loss, fetal death, and intrauterine growth restriction ( Satta and Biondi, 2019 ; Schreiber and Hunt, 2019 ). Dalteparin sodium, enoxaparin sodium, and nadroparin calcium are regarded as basic therapeutic drugs that meet the health requirement of patients.…”

Section: Discussionmentioning

confidence: 99%

Real-world pharmacological treatment of pregnant patients with rheumatic diseases from China: a retrospective analysis from 2016 to 2021

Jia,

Wang

2024

Front. Pharmacol.

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Introduction: We investigated trends in the use of therapeutic drugs for pregnant patients with rheumatic diseases in nine Chinese cities (Beijing, Chengdu, Guangzhou, Harbin, Hangzhou, Shanghai, Shenyang, Tianjin, and Zhengzhou) to provide a reference for drug use in clinic.Methods: Outpatient prescription data for pregnant patients diagnosed with rheumatic diseases in nine cities across China in 2016–2021 were extracted from the Hospital Prescription Cooperation Project of the Hospital Pharmacy Professional Committee of the Chinese Pharmaceutical Association. A retrospective analysis was then performed, incorporating data on patient age, defined daily doses (DDDs), defined daily cost (DDC), and other metrics.Results: In 2016–2020, more than 70% of the pregnant patients diagnosed with rheumatic diseases in these nine cities were 25 to < 35 years of age. The most common rheumatic diseases during pregnancy were antiphospholipid antibody syndrome (APS) and systemic lupus erythematosus (SLE). In terms of the routine use of daily therapeutic drugs, the DDDs of low molecular weight heparins (LMWHs), glucocorticoids, and immunosuppressive agents dominated the top three. Intravenous immunoglobulin (IVIG) and tumor necrosis factor inhibitors (TNFi) have been used since 2019 and had been in the forefront of the DDC.Conclusion: The number and total cost of prescriptions for therapeutic drugs of pregnancy complicated by rheumatic diseases, have increased significantly over the study interval. Conventional therapeutic drugs, especially glucocorticoids, LMWHs, and hydroxychloroquine were the most widely used drugs in pregnant patients with rheumatic diseases. However, IVIG and TNFi, relatively high cost, have shown gradual increases in clinical use since 2019.

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“…The first and direct mechanism involves a microbe or infectious toxin that damages the vascular wall leading to an inflammatory response. The second and indirect mechanism involves the microbe stimulating an immune response against blood vessels due to cross-reactivity between vascular and microbial antigens [15]. Previously, pulmonary infections such as influenza or SARS-CoV-2 have manifested with pulmonary involvement of ANCA-associated vasculitides [6, 12, 13].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Eosinophilic Granulomatosis with Polyangiitis following a <i>Clostridium difficile</i> Infection

Mohideen¹,

Weldemichael²,

Hussain³

et al. 2023

Case Rep Gastroenterol

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Eosinophilic granulomatosis with polyangiitis (EGPA), historically named Churg-Strauss syndrome, is a rare vasculitis affecting small- and medium-sized blood vessels. The disease has a predilection for numerous organs including the lungs, sinuses, kidneys, heart, nerves, and gastrointestinal tract but is prominently associated with asthma, rhinosinusitis, and eosinophilia. Gastrointestinal involvement is common; however, a gastrointestinal manifestation as the cardinal symptom following an infection is atypical. Here, we present a case of a 61-year-old male who presented with persistent diarrhea following a toxigenic <i>Clostridium difficile</i> infection despite multiple antibiotic courses. Repeat testing confirmed eradication of the infection, and further evaluation with colon biopsy revealed small and medium-sized vasculitis with eosinophilic infiltration and granulomas. Treatment with prednisone and cyclophosphamide resulted in rapid improvement of his diarrhea. Gastrointestinal symptoms in EGPA are associated with worse prognosis, so prompt identification and treatment of the disease is crucial. EGPA is rarely documented in histopathological samples from the gastrointestinal tract as endoscopic biopsies are typically too superficial to sample the submucosal layer containing the affected vessels. Additionally, the link between EGPA and infections as a potential trigger has not been clearly established, but gastrointestinal EGPA manifesting after a colonic infection raises concerns that this may have been a triggering event. Ultimately, further study is needed to understand, diagnose, and treat gastrointestinal and postinfection EGPA.

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Antiphospholipid syndrome and pregnancy

Cited by 9 publications

References 12 publications

Pregnancy outcomes in patients with primary antiphospholipid syndrome

Pregnancy outcomes in patients with primary antiphospholipid syndrome

Real-world pharmacological treatment of pregnant patients with rheumatic diseases from China: a retrospective analysis from 2016 to 2021

Gastrointestinal Eosinophilic Granulomatosis with Polyangiitis following a <i>Clostridium difficile</i> Infection

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