Pregnancy: Low-dose aspirin for prevention of pregnancy losses in women with primary antiphospholipid syndrome

Pregnancy loss, often recurrent, is one of the most importantclinical manifestations associated with the primary antiphospholipidsyndrome. In these cases, pregnancy wastage is related to thepresence of antiphospholipid antibodies, namely lupus anticoagulantand anticardiolipin antibodies, but patients do not have featuresof systemic lupus erythematosus or any other well-defined autoimmunedisease. We report here on the outcome of 21 consecutive pregnanciesin 18 patients with the syndrome who were treated with low-doseaspirin (100 mg/day) from 1 month before attempting conceptionand throughout the pregnancy. Low-dose prednisone (15–30mg/day) was added for potentially non-obstetric (autoimmune-related)reasons in six pregnancies. Patients were monitored as havinghigh-risk pregnancies. Prior to therapy, the rate of live-bornbabies was 6.1% (46 previous fetal losses and three live-bornbabies), and after therapy, it was 90.5% (21 pregnancies and19 live-born babies). Pre-term delivery due to maternal or fetalindications was required in 15% (3/20) of the viable pregnancies.Except for prematurity (20% of viable pregnancies) and its potentialassociated complications, there were no significant adverseeffects to either mothers or babies. Our treatment modalityis advocated for prevention of pregnancy losses in patientswith the ‘obstetric’ primary antiphospholipid syndrome.