Definitions:

phospholipids: your body is made up of cells. Phospholipids are important molecules that form the surface of cells including  blood cells and cells that line blood vessels.

antibodies: complex molecules that are produced by the cells of immune system. Normally, they protect our body from foreign molecules that are called antigens. They bind antigens and make them harmless. When antibodies target molecules of the human body they are called autoantibodies. Autoantibodies can be harmful and cause different diseases.

In some people, the immune system develops antibodies to phospholipids. These antiphospholipid antibodies may increase the risk of developing blood clots and may also cause an increased risk of miscarriage or stillbirth in pregnant women. Some people have these antibodies and do not develop clots or miscarriages.

People who have these antibodies and develop blood clots or pregnancy-related complications are said to have a syndrome called the antiphospholipid syndrome. It  is an autoimmune disorder. It means that the body’s immune system mistakenly attacks healthy tissues and organs.

Antiphospholipid syndrome is more common in women and in patients with other autoimmune or rheumatic diseases, for example, systemic lupus erythematosus. When it occurs in the absence of a connective tissue disease it is called “primary”. When it happens with other diseases, for ex.,  lupus or Sjogren’s syndrome it is called “secondary”.

The symptoms of antiphospholipid syndrome are related to abnormal blood clotting, miscarriage, or stillbirth. Blood clots can developed in any artery or vein.  Blood flow to and function of important organs can be affected, depending on where the clot is located. It can present, for ex, as a stroke or pain in the leg. Without treatment, patients often experience repeated clots.

 The diagnosis of antiphospholipid syndrome requires following:

●An episode of blood clots, one or more miscarriages after the 10th week of pregnancy, three or more miscarriages prior to the 10th week of pregnancy, or one or more premature births prior to the 34th week of pregnancy due to eclampsia.

●Antiphospholipid antibodies detected with blood testing on at least two different occasions at least 12 weeks apart. Antiphospholipid antibody tests include the lupus anticoagulant, anti-cardiolipin antibodies, and anti-beta-2-glycoprotein I antibodies.

Treatment of antiphospholipid syndrome includes life long anticoagulation. Anticoagulants are medications that prevent an existing blood clot from enlarging and that prevent the formation of additional blood clots. Anticoagulants are incorrectly referred to as blood thinners. Most commonly used anticoagulant is warfarin and it is taken through the  mouth. Its use requires blood work monitoring. Xarelto is newly developed anticoagulant that does not require regular blood work monitoring.

Pregnancy and antiphospholipid syndrome:

Pregnant women with antiphospholipid syndrome have an increased risk of  having a miscarriage compared with pregnant women without it. It can happen because of development of the clots in placenta. They may also be at risk for other pregnancy-related complications, such as preeclampsia and decreased blood flow to the fetus. It can cause a decreased weight of the baby.

Several treatments are available to reduce these risks. For women who have antiphospholipid antibodies but no history of blood clots or miscarriage, treatment may or may not be recommended.

The available treatments include:

Low-dose aspirin may be used for pregnant women with antiphospholipid syndrome in combination with other treatments, including heparin injections. Low-dose aspirin can be started before the woman attempts to become pregnant and is usually stopped sometime after two months to 36 weeks of gestation. Aspirin can be restarted after delivery and is usually taken for at least six to eight weeks postpartum.

Heparin must be given as an injection, either under the skin or into a vein. Most pregnant women who use heparin are taught to give their own injections into the skin.

Heparin is usually started once pregnancy is confirmed and is usually stopped temporarily for planned procedures (amniocentesis, cesarean section) and when labor begins. Either heparin or warfarin is recommended for six to eight weeks after delivery.

Warfarin is not usually recommended for pregnant women with antiphospholipid syndrome because of the potential risks to the developing fetus. If warfarin is used, it must be stopped before six weeks of pregnancy. It may be restarted after 14 weeks of pregnancy but must be discontinued by 36 weeks of pregnancy. Another anticoagulant (eg, heparin) is usually recommended when warfarin is not used.

Warfarin can be restarted after delivery and is often the preferred treatment for women with antiphospholipid syndrome during the postpartum stage (the six to eight weeks following delivery). Warfarin is safe to take while breastfeeding.

Women with antiphospholipid syndrome should not use birth control methods that contain estrogen because estrogen can increase the risk of developing a blood clot. A number of other methods of birth control are available, including progestin-only pills, an intrauterine device, condoms, a diaphragm, or an injection (eg, Depo Provera).