Do low-risk pregnant women with antiphospholipid antibodies need to be treated?
Abstract
We identified 19 women who had persistently positive test results for antiphospholipid antibodies who were considered to be at low risk because they had none of the associated signs or symptoms of the antiphospholipid antibody syndrome. They had had no (10/19, 53%) or just one prior spontaneous abortion and did not have a history of thrombosis or thrombocytopenia. Many (8/19, 42%) had had a prior uncomplicated pregnancy ending in a live birth. These women were randomly assigned to receive low-dose aspirin (81 mg daily) or usual care. There were few obstetric complications recorded in either treatment group. One woman in the aspirin group had a fetal death, and one in the usual care group had a low-birth-weight infant. The frequency of complications was so low that > 600 such women would need to be entered into a randomized trial to evaluate whether low-dose aspirin would be beneficial treatment during a pregnancy. We concluded that treatment of pregnant women with antiphospholipid antibodies who are otherwise at low risk cannot be justified on the basis of the available evidence.
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Data from one placebo-controlled RCT in six women with SLE and three low-quality studies in women without SLE found no difference in live birth prevalence with LDA use.
“Data from one placebo-controlled RCT of LDA in six women with SLE42 and data from three low-quality studies (two RCTs, one retrospective cohort)43–45 of women without SLE found no difference in the prevalence of live births with use of LDA.”
From EULAR recommendations for the management of antiphospholipid syndrome in adults (2019) · cites this paper as [43]
Cites
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Self-citationSilver, R. K., MacGregor, S. N., Sholl, J. S., Hobart, J. M., Neerhof, M. G., & Ragin, A. B. (1993) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(93)90410-k · Cited by 278 · see citing works
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VTE, Thrombophilia, Antithrombotic Therapy, and Pregnancy
Bates, S. M., Greer, I. A., Middeldorp, S., Veenstra, D. L., Prabulos, A.-M., & Vandvik, P. O. (2012) · Chest · doi:10.1378/chest.11-2300 · Cited by 1,525 · see citing works
EULAR recommendations for the management of antiphospholipid syndrome in adults
Tektonidou, M. G., Andreoli, L., Limper, M., Amoura, Z., Cervera, R., Costedoat-Chalumeau, N., Cuadrado, M. J., Dörner, T., Ferrer-Oliveras, R., Hambly, K., et al. (2019) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2019-215213 · Cited by 1,261 · see citing works
Guidelines on the investigation and management of antiphospholipid syndrome
Keeling, D., Mackie, I., Moore, G. W., Greer, I. A., Greaves, M., & British Committee for Standards in Haematology (2012) · British Journal of Haematology · doi:10.1111/j.1365-2141.2012.09037.x · Cited by 740 · see citing works
Pregnancy outcome in different clinical phenotypes of antiphospholipid syndrome
Bramham, K., Hunt, B., Germain, S., Calatayud, I., Khamashta, M., Bewley, S., & Nelson-Piercy, C. (2010) · Lupus · doi:10.1177/0961203309347794 · Cited by 185 · see citing works
Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy
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Del Ross, T., Ruffatti, A., Visentin, M. S., Tonello, M., Calligaro, A., Favaro, M., Hoxha, A., & Punzi, L. (2013) · The Journal of Rheumatology · doi:10.3899/jrheum.120576 · Cited by 60 · see citing works
Care prior to and during subsequent pregnancies following stillbirth for improving outcomes
Wojcieszek, A. M., Shepherd, E., Middleton, P., Lassi, Z. S., Wilson, T., Murphy, M. M., Heazell, A. E., Ellwood, D. A., Silver, R. M., & Flenady, V. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012203.pub2 · Cited by 55 · see citing works
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- Authors
- Cowchock, S., & Reece, E. A.
- Affiliations
- Thomas Jefferson University (US)
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 1997-05
- Volume
- 176
- Issue
- 5
- Pages
- 1099-1100
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2076127201
- Cited by
- 127
- References
- 2
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 2 · 2021: 3 · 2020: 2 · 2019: 10 · 2018: 7 · 2017: 3 · 2016: 2 · 2015: 3 · 2014: 4 · 2013: 6 · 2012: 5
- FWCI
- 2.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (080-02154)
- Topics
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- antiphospholipid antibodies, antiphospholipid syndrome, low-risk pregnancy, low-dose aspirin, thromboprophylaxis, miscarriage, thrombosis, thrombocytopenia, fetal death, low birth weight
- MeSH terms
- Aspirin, Female, Humans, Pregnancy, Pregnancy Complications, Risk Factors, Antiphospholipid Syndrome, Antibodies, Antiphospholipid
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