A study of 75 pregnancies in patients with antiphospholipid syndrome

Objective. To describe a French tertiary referral center experience in the treatment of pregnancies in patients with the antiphospholipid syndrome (AP S). Methods. Retrospective review of the data of 75 consecutive pregnancies in 47 women. Results. After exclusion of induced abortions and pregnancies occurring bef ore APS onset, the prior live birth rate was 7.9%. Forty-nine pregnancies o ccurred in women with history of vascular thrombosis, 17 with history of th rombocytopenia. Heparin was prescribed in 39 pregnancies, associated with a spirin in 35 cases, and aspirin alone was used in 36 as first-line therapy. Corticosteroids were prescribed in 38 pregnancies. Three pregnancies by in vitro fertilization led to one embryonic loss. one full term birth, and on e premature birth. Six pregnancies treated with immunoglobulin ended in one fetal death, 2 premature and 3 full term deliveries. The outcome of the ot her 66 pregnancies was one embryonic loss, 8 fetal deaths, 16 prematures, a nd 38 full term births. Use of corticosteroids correlated with severe prema turity (p=0.005), preeclampsia (p=0.014), intrauterine growth retardation ( p=0.005), and presence of disease associated to APS (p=0.009). After exclus ion of one fetal death associated with congenital anomaly, live birth rate was 72.9%. There was a trend for higher rate of fetal survival in patients without history of vascular thrombosis (84.6 vs 66.4%; P=0.11). Conclusion. Obstetrical prognosis in APS was improved by antithrombotic the rapy. Studies are needed to define individual risk and specific significanc e of the various antiphospholipid antibodies, in order to improve the respe ctive indications for aspirin alone or with heparin in women without thromb otic events.