Abstract:
The antiphospholipid syndrome (APS) is characterized by arterial and venous thrombosis and pregnancy complications that include recurrent early pregnancy loss and late adverse pregnancy outcomes such as fetal death, severe preeclampsia, placental insufficiency, and fetal growth restriction. The goals of treatment for APS during pregnancy are to reduce or eliminate the risk of thromboembolic events and to improve maternal and fetal outcome by reducing the risk of these complications. Although the routine use of prophylactic-dose unfractionated heparin or low-molecular-weight heparin plus low-dose aspirin is generally advocated for pregnant women with APS and adverse obstetric outcome, this approach is supported by questionable data since these women are underrepresented in clinical trials. Corticosteroids and intravenous immunoglobulin (IVIG) are not recommended for first-line management of treatment of pregnant women with APS. Warfarin is generally contraindicated, and its use should be limited to special conditions. Since most treatment regimens proposed for women with APS carry a significant risk for both the mother and the fetus, each woman should be extensively counseled, and therapeutic options should be individually tailored based on her individual risk of antiphospholipid antibody (aPL)-mediated complications. © 2009 Elsevier B.V. All rights reserved.