High-Risk Pregnancy and the Rheumatologist
High-Risk Pregnancy and the Rheumatologist
APS is associated with poor pregnancy outcomes, including recurrent early miscarriage and features of placental insufficiency such as pre-eclampsia, intra-uterine growth restriction and SGA neonates. Women who have had thrombotic complications have poorer outcomes than those with only obstetric complications. Low-dose aspirin (75–100 mg/day) is often prescribed to reduce the risk of miscarriage and pre-eclampsia.
Women with previous thrombosis require LMWH prophylaxis in pregnancy. LMWH has also been shown to improve outcomes in those with previous placenta-mediated adverse outcomes such as severe early-onset pre-eclampsia with growth restriction. However, the use of LMWH to prevent recurrent early pregnancy loss is controversial, with large randomized trials in the general population not demonstrating improved outcome. Even in women with specific thrombophilias, a systematic review of 43 studies failed to show improved obstetric outcomes with the use of LMWH.
aCLs were found in 10% and lupus anticoagulant in 8% of healthy blood donors. Most studies of women with aPL are muddied by the inclusion of women with SLE or a single titre measurement of aPL in pregnancy. A cross-sectional study comparing obstetric outcomes in women (without SLE) with persistently positive aPL and those with obstetric APS and also with the normal population showed that those with persistently positive aPL (without a clinical history of APS) on aspirin had similar obstetric outcomes compared with the normal population.
A review on recurrent pregnancy loss concluded that aCL is less likely to play a major role. In SLE, however, lupus anticoagulant was the strongest predictor of adverse pregnancy outcome.
APS and aPL
APS is associated with poor pregnancy outcomes, including recurrent early miscarriage and features of placental insufficiency such as pre-eclampsia, intra-uterine growth restriction and SGA neonates. Women who have had thrombotic complications have poorer outcomes than those with only obstetric complications. Low-dose aspirin (75–100 mg/day) is often prescribed to reduce the risk of miscarriage and pre-eclampsia.
Controversies of LMWH Use: Who Should Be Offered Treatment?
Women with previous thrombosis require LMWH prophylaxis in pregnancy. LMWH has also been shown to improve outcomes in those with previous placenta-mediated adverse outcomes such as severe early-onset pre-eclampsia with growth restriction. However, the use of LMWH to prevent recurrent early pregnancy loss is controversial, with large randomized trials in the general population not demonstrating improved outcome. Even in women with specific thrombophilias, a systematic review of 43 studies failed to show improved obstetric outcomes with the use of LMWH.
Do Women With Persistent aPL Have the Same Obstetric Risks as Those With APS?
aCLs were found in 10% and lupus anticoagulant in 8% of healthy blood donors. Most studies of women with aPL are muddied by the inclusion of women with SLE or a single titre measurement of aPL in pregnancy. A cross-sectional study comparing obstetric outcomes in women (without SLE) with persistently positive aPL and those with obstetric APS and also with the normal population showed that those with persistently positive aPL (without a clinical history of APS) on aspirin had similar obstetric outcomes compared with the normal population.
A review on recurrent pregnancy loss concluded that aCL is less likely to play a major role. In SLE, however, lupus anticoagulant was the strongest predictor of adverse pregnancy outcome.
