Antiphospholipid syndrome and pregnancy
Antiphospholipid syndrome (APS) is an autoimmune disorder in which the body’s immune system makes antibodies that attack and damage its own tissues or cells.
Normally the immune system makes antibodies to attack infections, but in APS antibodies are made against phospholipids – a type of fat found in many different cells and tissues. It is also known as Hughes Syndrome or sticky blood syndrome.
If you have APS you will have a combination of the following:
- antiphospholipid antibodies (aPL)
- blood clots and/or
- pregnancy problems, including miscarriage or preterm birth.
APS is also linked to stroke, heart attack and kidney damage.
It is possible to just have antiphospholipid antibodies (aPL) but not to have any symptoms or health problems. In this case you would not be classed as having antiphospholipid syndrome.
In pregnancy, APS is linked to recurrent miscarriage, intrauterine growth restriction, preterm birth and pre-eclampsia. If you have had three or more first trimester miscarriages or one or more second trimester miscarriages it is one of the screening tests you be offered to look for possible causes because it is one of the most treatable causes of recurrent miscarriage.
What does it mean for me and my baby?
If you already know you have APS, tell your GP or midwife as soon as you know you are pregnant so you can get the right treatment. Although APS cannot be cured, its complications and symptoms, including pregnancy complications, can be reduced.
If APS is suspected due to recurrent miscarriage or other symptoms, you will be offered a test for the syndrome. This will be done with two blood tests looking for antibodies that are at least 6-12 weeks apart.
With treatment, usually aspirin and heparin, the risk of miscarriage is much lower, but there is still a risk of premature delivery and complications such as pre-eclampsia.
If you have APS you and your baby will be monitored closely throughout your pregnancy for pre-eclampsia and intrauterine growth restriction. The anti-blood-clotting (anti-coagulant) treatment you will receive during pregnancy will be adjusted during or just before labour to prevent heavy blood loss. You and your baby will be monitored very carefully during labour and birth.
If APS did not affect you before you became pregnant you may still be monitored and treated for some time after the birth to make sure you continue to be unaffected after pregnancy.
Ismail A et al (2013) Role of Antiphospholipid Antibodies in Unexplained Recurrent Abortion and Intrauterine Fetal Death. Life Science Journal, 2013. 10(1).
Keeling D, Mackie I (2012) Guidelines on the Investigation and Management of Antiphospholipid Syndrome. BJH Guideline. Wiley Online Library
RCOG (2011) The Investigation andTreatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage. 2011, Royal College of Obstetricians and Gynaecologists.
James D, Steer P (2011) High risk pregnancy, management options. Fourth edition ed. 2011: Elsevier Saunders.
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