Antiphospholipid syndrome in pregnancy

Abstract

Antiphospholipid syndrome is a heterogenous disorder with many pregnancy-related complications. Despite the refinement of laboratory testing and classification criteria, controversy continues regarding the management of women with antiphospholipid antibodies (aPLs) in pregnancy. This is compounded by the lack of large randomized placebo-controlled trials in pregnancy. This article attempts to address some of the controversies and suggest management guidelines. The issues discussed include: pathogenesis and clinical relevance of aPLs, clinical implications of aPLs for the mother and fetus, management of the different clinical phenotypes of antiphospholipid syndrome and its overlap with systemic lupus erythematosus, treatment options in pregnancy and breast feeding. We review controversies regarding the appropriateness of anticoagulant use in women with recurrent pregnancy losses and aPLs, and issues surrounding heparin dosing regimens. We have also included suggestions for the directions of future studies. © 2010 Expert Reviews Ltd.