What Is Antiphospholipid Syndrome and How Can It Affect Pregnancy?

Many different factors increase the chances of complications during pregnancy, one of which is antiphospholipid syndrome (APS) or Hughes syndrome, a condition where the immune system attacks the body's healthy cells.

"Antiphospholipid syndrome is an acquired autoimmune disorder [that] clinically presents as recurrent venous or arterial thrombosis and/or fetal loss," said Priya Bansal, M.D., who is board certified in internal medicine, allergy and immunology, and a member of the faculty at Northwestern University Feinberg School of Medicine, with a practice at Asthma and Allergy Wellness Center in St. Charles, Illinois.

This syndrome can cause clots in the arteries and veins in areas such as the legs, kidneys, lungs and other organs, which can lead to stroke and heart attack, and during pregnancy is associated with miscarriage and stillbirth.

Antibodies usually protect an organism against bacteria and viruses, however, with antiphospholipid syndrome "our body's immune system mistakenly makes antibodies that attack phospholipid-binding proteins in our cells," Bansal explained.

The causes of antiphospholipid syndrome

Although the exact reasons some patients develop antiphospholipid syndrome are not fully understood, it is known that it is an autoimmune condition and can sometimes be caused by genetics, said Allison K. Rodgers, M.D., who is board-certified in OB-GYN, reproductive endocrinology and infertility, and works at Fertility Centers of Illinois in Chicago.

Environmental factors, such as infection, may contribute to the activation of the autoimmune disorder as well. Although it may be present in the body on its own, antiphospholipid syndrome may be related to an underlying disease, such as systemic lupus erythematosus, and it affects five times more women than men, according to the American College of Rheumatology.

Antiphospholipid syndrome in pregnant women

"In a pregnant patient, [APS] can present as one or more spontaneous abortions after 10 weeks of gestational age; one or more premature births, less than 34 weeks gestational age, because of severe preeclampsia or eclampsia or severe placental insufficiency; or three or more consecutive, unexplained spontaneous abortions before 10 weeks of gestational age," Bansal said.

Approximately 10 percent to 15 percent of women who have had recurrent miscarriages are diagnosed with APS, according to a 2011 article published in the Journal of Prenatal Medicine. It stated that many of the obstetric complications associated with this autoimmune disorder are caused by a hypercoagulable state responsible for thrombosis. Obstetric complications are the hallmark of antiphospholipid syndrome, according to this research.

Some of the most severe complications potentially occurring during pregnancy are:

• Recurrent miscarriage
• Intrauterine growth restriction
• Early delivery
• Fetal or neonatal thrombosis
• Oligohydramnios (too little amniotic fluid)
• HELLP syndrome (a complication of high blood pressure)
• Fetal distress
• Preeclampsia/eclampsia (characterized by high blood pressure)
• Placental insufficiency
• Arterial or venous thrombosis

What to do before pregnancy

It is critical for women who have been diagnosed with antiphospholipid syndrome to have a medical checkup before conceiving—this will increase the chances and decrease the risks. Although there is no cure for APS, proper medical monitoring, along with medication, can reduce the tendency of clot formation.

Precautions before pregnancy, according to Bansal, include:

• Optimizing control with a rheumatologist if the patient has a concurrent autoimmune disease
• Genetic counseling
• Medications
• Quitting smoking
• A healthy lifestyle—weight, diet and exercise—before pregnancy

What to do during pregnancy

It is possible to complete a full-term pregnancy with APS. It is easily treated with a blood thinner, Rodgers said. Treatments help maximize the chances for expectant mothers, however, each patient must be monitored individually by a team of specialists, such as a rheumatologist and a high-risk OB-GYN.

"If the patient is on steroids, then supplementation should be done to cover the delivery time," Bansal indicated. "If the platelet count drops, an epidural anesthetic is not recommended."

In addition, the optimal time for delivery in these patients is 37 weeks, she advised.

When patients have no history of complications, they may not be given any medications.

"[However,] if the patient has APS and a history of pregnancy complications, they can be given aspirin or low-dose heparin injections," Bansal added. "If they have a history of thrombotic events, they may be given both together."

Pregnant women should watch for symptoms of complications, including signs of a blood clot, low platelet count and preeclampsia, Bansal explained. Likewise, care doesn't end at delivery; these patients should be closely monitored due to an increased risk of postpartum blood clots.

"There are no known side effects of breastfeeding in APS. However, if on cytotoxic medication, this should be examined and managed with the prescribing physician," Bansal said.

Lifestyle for pregnant women with APS

In all pregnancies, women should be attentive to their general health, however, patients with antiphospholipid syndrome should be aware of the risk of blood clots.

"I would avoid lifestyle choices that increase risks of blood clotting," Rodgers said.

She also recommended:

• Not using nicotine or marijuana
• Making sure to get plenty of exercise
• Eating a healthy diet
• Standing and walking about every 90 minutes while traveling

Other recommendations made by experts include maintaining good oral hygiene, drinking enough water, not doing impact sports, wearing comfortable clothes (avoiding high heels) and keeping close follow-ups with healthcare specialists.