Background Recurrent pregnancy losses are the most common obstetric manifestation of antiphospholipid syndrome (APS). Despite standard therapy with low dose aspirin (LDA) and low molecular weight heparin (LMWH), the rate of successful pregnancies is not greater than 70%. Corticosteroids have been suggested as a potential therapy in these patients. Our aim is to describe a cohort of patients with obstetric APS treated with low dose corticosteroids.
Methods Retrospective study including 9 women diagnosed with primary APS. Clinical records were reviewed to obtain demographic and clinical data.
Results Two women had a history of thrombosis, while the remaining 7 had merely obstetric manifestations. All had suffered from early pregnancy losses and 1 of them also had a history of fetal death. We studied 42 pregnancies in these women. The mean number of pregnancies was 4.67±0.71 per woman. Maternal age was 35.8±4.6 years. Overall there were 30 abortions (71.4%) and 1 fetal death (2.4%) Regarding treatments used during pregnancy, 25 (59.5%) pregnancies were on some treatment: LDA (25), LMWH (24), corticosteroids (13), and intravenous immunoglobulins (IVIG) (4). As expected, in all pregnancies treated with corticosteroids, these drugs were combined with LDA and LMWH. When analyzing the effect of therapies, we found a tendency to decrease pregnancy loss in pregnancies treated with LDA (64 vs 82.4%; p=0.3) and LMWH (62.5 vs 83.3%; p=0.18). Treatment with corticosteroids, significantly increased the rate of successful pregnancy (the rate of pregnancy loss was 38.5% in treated vs 86.2% in non treated pregnancies; p=0.003). The results of the global pregnancy analysis were confirmed by bivariate and multivariate GEE analysis. In the bivariate analysis, LDA tended to be protective (OR=0.38, CI 0.11–1.33; p=0.129) and LMWH and corticosteroids significantly protected against pregnancy loss (OR=0.34, CI 0.13–0.85; p=0.021; and OR=0.17, CI 0.06–0.51; p=0.002, respectively). After multivariate analysis, only corticosteroids remained inversely associated with pregnancy loss (OR=0.09, CI 0.012–0.683; p=0.020). However, the independent effects of LDA/LMWH could not be adequately tested because all patients on corticosteroids were also treated with LDA and LMWH. As adverse events, 2 cases of gestational diabetes and 1 of preeclampsia were observed.
Conclusions The addition of corticosteroids to standard therapy with LDA and LMWH seems to be safe and effective for improving the pregnancy outcome in women with obstetric APS.
Funding Source(s): This work was supported by a next-Val grant from IDIVAL (NVAL 17/19)
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