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Background and Aims

Antimalarials have pleiotropic functions including anti-inflammatory, anti-aggrecant and immunoregulatory properties. Adverse pregnancy outcomes in primary OAPS despite anticoagulation, dictates the need for further measures. Experimental evidence exists that HCQ might decrease the incidence of thrombosis. The aim of the present study was to determine the effectiveness and to assess safety of HCQ during OAPS pregnancy (maternal and foetal outcome).

Methods

A total of 34 pregnant patients, (mean age 36.2 years and mean disease duration 4.2 years) with similar characteristics (age, sex, body mass index, ethnicity, disease duration) diagnosed according to the revised international criteria were recruited. All patients were prescribed low dose aspirin and low molecular weight heparin as well as HCQ 200 mg bid throughout the pregnancy. Thrombotic incidence before, during and after the pregnancy was analysed. Lupus anticoagulant was positive in 33(97%) cases, anticardiolipin antibodies were positive in 31(91%) cases; IgG was positive in 32(94 %), IgM positive in 31(91%) and anti-b2 glycoprotein antibodies were positive in 32 (94%) of cases.

Results

Thirty-two cases (94%) had successful pregnancy. Two patients (5.9%) had premature delivery. No fatal cases were recorded. No congenital abnormalities were observed and mean follow up of 24 months revealed no abnormalities in the infants. No new thrombi (arterial and venous) were recorded throughout the pregnancy. Previous events of vascular thrombosis (arterial and/or venous) were recorded at diagnosis in 42% of patients, previous obstetrical event in 38%, both venous and arterial thrombosis in 26% of cases.

Conclusions

The “immunomodulatory” approach of HCQ is effective in improving pregnancy outcome in primary OAPS.

Background and Aims

Recurrent reproductive failure includes repeated pregnancy loss or implantation failure. The only accepted immunological abnormality of recurrent pregnancy loss in international guidelines is the presence of antiphospholipid antibodies. There are no well-accepted immunological factors of repeated implantation failure. However distinct studies have demonstrated the potential role of other autoantibodies mainly among women with recurrent pregnancy loss. In this study we preliminary evaluated the efficacy and safety of low-dose prednisone in a small number of women with autoimmune reproductive failure.

Methods

In this study we defined autoimmune reproductive failure as a previous history of primary recurrent pregnancy loss (more than 3 pregnancy losses) or recurrent implantation failure in the presence of antinuclear or anti-thyroid antibodies with or without C3 or C4 hypocomplementemia. None of the patients disclosed full-blown SLE. After informed consent the women were treated with low-dose prednisone (10 mg/day) from the day of a positive pregnancy test to week 12 of pregnancy. A prospective follow-up was performed to assess efficacy and safety.

Results

4 out of 12 women with autoimmune reproductive failure were treated with low-dose prednisone. During follow-up none of these patients developed severe infections, diabetes, arterial hypertension or pre-eclampsia. All women delivered healthy newborns with normal APGAR scores. None of the infants were born prematurely.

Conclusions

Treating women who had antinuclear antibodies and recurrent reproductive failure with low-dose prednisone during the first 3 months of pregnancy was effective in promoting live birth in a small serie of cases. The role of this immuneguided therapy warrants evaluation in a clinical trial.

Background and Aims

Obsteric Antiphospholipid Syndrome (OAPS) is the most frequently treatable acquired cause of thrombosis and placental dysfunction during pregnancy. In women carrying antiphospholipid antibodies (aPL), it is possible to find an inherited thrombophilic disorder (ITP). However, the association between obstetrical complications and ITP in OAPS women is still debated. We aimed to evaluate ITP and clinical features from a cohort of OAPS women in order to explore foetal-maternal outcomes according to laboratory categories.

Methods

In this study, we analyzed data from a monocentric cohort of Caucasian women who fullfilled the Sydney Criteria of APS. All thrombotic events, obstetrical complications, and concomitant autoimmune disorders were documented. Laboratory data included common ITP (protein C, protein S, FV Leiden and FII G20210A mutations), and autoantibodies (aPL, antibodies of connective tissue disease - CTD, and anti-thyroid autoantibodies).

Results

All of women were in the fertility age at APS diagnosis. Most of them were non-smokers and with normal body mass index. ITP were registered in 15% of women cohort. CTD-associated antibodies were found in 30% of women while thyroid autoimmunity was revealed in 20%. Live-birth was achieved in 80% of the cohort. The most prevalent obstetrical complications were recurrent miscarriage (50%) and preterm delivery <37 w (10%).

Conclusions

Our findings indicate that relevant associations can occur between laboratory categories and pregnancy outcomes in OAPS women.

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