Management of Rheumatologic Diseases in Pregnancy

Oier Ateka-Barrutia; Catherine Nelson-Piercy

Disclosures

Int J Clin Rheumatol. 2012;7(5):541-558. 

In This Article

aPL & APS

aPL are found more frequently in patients with SLE (30–40%) than in any other autoimmune rheumatic disease or in the general population (1–5%),[82] and represent one of the major risk factors for poor obstetric outcome. Several studies have identified aPL-positive women at increased risk of developing preeclampsia, IUGR, prematurity and fetal loss.[83–86] Positivity for both anticardiolipin antibodies and lupus anticoagulant; triple aPL positivity (anticardiolipin antibodies, lupus anticoagulant and anti-β2-glycoprotein-I); high titres of anticardiolipin antibodies; or history of thrombotic APS multiply such risk.[84,87] Moreover, women with thrombotic APS have worse obstetric outcomes than those with obstetric APS or aPL carriers.[87,88] As the existence of aPL also raises the risk for maternal thrombosis, rechecking aPL shortly prior to pregnancy in patients with a previous diagnosis of SLE or other rheumatic disease is advisable.

Treatment of women with obstetric APS is still controversial and should be individualized, as most of the evidence is based on observational studies.[89] A detailed discussion of APS in pregnancy is out with the remit of this review and readers are directed to a recent review on this topic.[90] Current recommendations include low-dose aspirin (LDA) alone or with additional prophylactic low-molecular-weight heparin (LMWH), as soon as pregnancy is confirmed, for women with recurrent early miscarriages (<10 weeks of gestation), and LDA plus prophylactic LMWH for women with previous fetal death (>10 weeks of gestation) and/or preterm delivery (<34 weeks of gestation due to uteroplacental problems).[89,91]

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