Antiphospholipid Syndrome (aPL)

What is antiphospholipid syndrome (aPL)?

Antiphospholipid syndrome is an autoimmune disease in which the body produces large amounts of antiphospholipid antibodies. Phospholipids are a special type of fat containing phosphate that makes up the outer walls of the body's cells. Antiphospholipid antibodies attack the phospholipids. This causes many different problems including increased blood clotting. Cardiolipin is one type of phospholipid and specific anticardiolipin antibodies may develop.

This disease is generally characterized by the following:

• Thrombosis--blood clots in arteries or veins (especially in the legs). Clots in vessels of the central nervous system (brain and spinal cord) can result in stroke.

• Thrombocytopenia--low platelets (cells important in blood clotting).

• Pregnancy loss (especially repeated losses)

Antiphospholipid syndrome was only defined in recent years and is sometimes called Hughes syndrome, or sticky blood syndrome. The disease may occur along with other autoimmune diseases such as systemic lupus erythematosus (SLE, or lupus).

Antiphospholipid syndrome is often difficult to diagnose, however, blood tests for antibodies including lupus and anticardiolipin may aid in the diagnosis.

How does pregnancy affect antiphospholipid syndrome (aPL)?

It is not clear whether aPL is worsened or unchanged by pregnancy.

How does antiphospholipid syndrome (aPL) affect pregnancy?

This disease can have serious effects in pregnancy, both for the mother and the baby. Risks for several complications are increased in women with aPL, and may include, but are not limited to, the following:

• Stroke

• Blood clots

• Gestational hypertension (high blood pressure of pregnancy)

• Stillbirth (fetal death)

• Recurrent miscarriage

• Intrauterine growth restriction (poor fetal growth)

• Preterm birth

Management of antiphospholipid syndrome (aPL) during pregnancy

Because of the higher risks for stroke, pregnancy loss, and other complications with aPL, mothers need close monitoring of the disease. More frequent prenatal visits are often needed.

Medication for aPL may need to be changed (type and/or dosage) during pregnancy. Consult your doctor for more information.

Testing during pregnancy with aPL may include the following:

• Blood tests for aPL (specific antibodies that help track the severity of the disease)

• Blood clotting levels in the blood

• Monitoring for signs of gestational hypertension

• Ultrasound--a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels used to monitor fetal growth and development.

• Fetal heart monitoring (to check the fetal heart rate for signs of distress)

• Other fetal testing, including Doppler flow studies (to monitor the blood flow in the uterus and umbilical cord)

Women with aPL can increase their chances for a healthy pregnancy by getting early prenatal care and working with their health care providers in the management of their disease.