Update on the current recommendations and outcomes in pregnant women with antiphospholipid syndrome

Cecilia Beatrice Chighizolaab, Maria Gerosaac, Laura Trespidid, Alessio Di Giacomob, Federica Rossid, Barbara Acaiad & Pier Luigi Meroni*aba Department of Clinical Sciences and Community Health, University of Milan, Milan, Italyb Experimental laboratory of Immunology and Rheumatology Researches, Istituto Auxologico Italiano, Via Zucchi 18, 20095 Cusano Milanino, Milan, Italyc Department of Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italyd U.O. Ostetricia e Ginecologia I, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Milan, Italy*Author for correspondence: +39 0261 9112 554 +39 0261 9113 033 pierluigi.meroni@unimi.itPregnancy morbidity is part of the clinical spectrum of the antiphospholipid syndrome (APS), a chronic autoimmune condition serologically characterized by the persistent positivity of antiphospholipid antibodies (aPL). Antiplatelet and anticoagulant agents are the mainstay of the treatment of obstetric APS. However, there is an ongoing debate about the optimal management of women with most severe aPL-mediated obstetric complications, women not fulfilling APS criteria and those with refractory disease. Unfortunately, the literature cannot provide definite answers to these controversial issues, being flawed by many limitations. The evidence supporting the recommended therapeutic management of different aPL-related obstetrical clinical manifestations is presented, with a critical appraisal of each approach.