What are the guidelines for antiphospholipid syndrome (APS) prophylaxis during pregnancy?

Updated: Nov 24, 2020
  • Author: Suneel Movva, MD; Chief Editor: Herbert S Diamond, MD  more...
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Guidelines from the American College of Obstetricians and Gynecologists (based primarily on consensus and expert opinion [level C]) recommend that women with APS who have a history of thrombosis in previous pregnancies receive prophylactic anticoagulation during pregnancy and for 6 weeks postpartum. For women with APS who have no history of thrombosis, the guidelines suggest that clinical surveillance or prophylactic heparin use antepartum, along with 6 weeks of postpartum anticoagulation, may be warranted. [26]

Prophylaxis during pregnancy is provided with subcutaneous heparin (preferably low–molecular-weight heparin [LMWH]) and low-dose aspirin. Therapy is withheld at the time of delivery and is restarted after delivery, continuing for 6-12 weeks, or long-term in patients with a history of thrombosis.

The European League Against Rheumatism (EULAR) has published recommendations for women's health and the management of family planning, assisted reproduction, pregnancy, and menopause in patients with SLE and/or APS. EULAR also recommends prophylactic heparin and low-dose aspirin during pregnancy for patients with APS. [27]

Warfarin is contraindicated in pregnancy. Breastfeeding women may use heparin and warfarin.

Corticosteroids have not been proven effective for persons with primary APS, and they have been shown to increase maternal morbidity and fetal prematurity rates.

Unfortunately, current treatment fails to prevent complications in 20 to 30% of APS pregnancies. [28, 29] Retrospective clinical studies suggest that treatment with hydroxychloroquine may help prevent pregnancy complications in women with aPL and APS, and this strategy is currently being studied in a randomized controlled multicenter trial. [29]

See also Antiphospholipid Syndrome and Pregnancy.

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