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Semin Thromb Hemost 2023; 49(04): 337-347
DOI: 10.1055/s-0042-1756193
Review Article

Antiphospholipid Antibodies in Pregnancy: Maternal and Neonatal Implications

Jean-Christophe Gris
1   Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
2   Department of Hematology, Faculty of Pharmaceutical and Biological Sciences, Montpellier University, France
3   UMR UA11 INSERM IDESP - Montpellier University, France
4   Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
,
Florence Guillotin
1   Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
,
Mathias Chéa
1   Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
,
Chloé Bourguignon
1   Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
3   UMR UA11 INSERM IDESP - Montpellier University, France
,
Éva Nouvellon
1   Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
3   UMR UA11 INSERM IDESP - Montpellier University, France
,
Sylvie Bouvier
1   Department of Hematology, CHU Nîmes, Univ Montpellier, Nîmes, France
2   Department of Hematology, Faculty of Pharmaceutical and Biological Sciences, Montpellier University, France
3   UMR UA11 INSERM IDESP - Montpellier University, France
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Abstract

Antiphospholipid antibodies (aPL Abs) have long been associated with the occurrence of certain specific pregnancy morbidities, affecting both mother and fetus. Antithrombotic-based prophylactic regimens are the standard of care. Their intensity is modulated by the thrombotic history and has greatly improved the prognosis related to spontaneous morbidity. Observational studies show that this treatment is still associated with the persistence of excess of late-pregnancy placental diseases, calling for new or complementary developments, yet to be validated. Rigorous prospective multicentric validation of clinical and laboratory parameters capable of identifying those women and fetuses at a risk of pejorative evolution, thus early prognosis, is a priority issue. These will make it possible to develop customized treatments and test them. Furthermore, there are still concerns, particularly neurodevelopmental ones, about children born to aPL Ab-positive mothers, and clarification based on regular, more systematic evaluations is required. Even after pregnancy, women with a pure obstetrical antiphospholipid syndrome are at a greater risk of venous and arterial thrombosis over time, and prevention needs to be improved. These women also appear to develop more psychiatric and mood disorders. Central nervous system imaging using high-resolution techniques has shown subtle impairments in the white matter, associated with the most pathogenic aPL Abs and the clinical significance of this is under investigation. These mothers also seem to develop an excess of cancers. The systemic impact of aPL Abs is gradually being suspected, although this requires further evidence, and prevention should be envisaged.

Keywords

antiphospholipid antibodies - pregnancy - placental disease - mother - neonate - thrombosis - psychiatric - cancer


Publication History

Article published online:
15 September 2022

© 2022. Thieme. All rights reserved.

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