Can People with Antiphospholipid Syndrome (APS) Have Successful Pregnancies?
by Dr. Michael Lockshin
So, can people with antiphospholipid antibody have successful pregnancies?
The short answer is yes… with a couple of footnotes.
First, it depends a bit on how you were defined as having antiphospholipid antibody.
There are three different blood tests:
- A positive lupus anticoagulant test, a type of clotting test, if present, indicates the highest risk (for losing the baby or having another complication of pregnancy). However, it is easy to get a wrong answer in this test if the doctor or the laboratory are not familiar with it and don’t handle the blood specimen properly.
- A positive test for anticardiolipin antibodies raises concern only if it is very strongly positive. Our own studies suggest that even a strongly positive test, if not accompanied by lupus anticoagulant, may not be as worrisome as we once thought.
- A positive test for antibodies to beta-2-glycoprotein I also has to be strongly positive to be worrisome, and even then, according to our studies, may not suggest high risk.
- The worst scenario is if all three tests are strongly positive.
Dr. Michael Lockshin, Rheumatologist
But don’t despair. These pregnancies are treatable. In our recent study (the largest and most detailed one done to date), pregnancy outcome was about the same as for women with diabetes, kidney disease, or poor socioeconomic conditions. More than 9 of 10 pregnancies survived, and about 8 of 10 pregnancies went to full term. Of course patients were very closely monitored and treated, mostly with a form of injectable heparin (a blood thinner). The common problems were prematurity and high blood pressure (a pregnancy complication seen in many circumstances); the problems occurred most often in patients who also had lupus.
So the answer is yes: women with antiphospholipid antibody have successful pregnancies. You have to be emotionally strong—it will be a very long nine months. And four people—you, your partner, your obstetrician, and your rheumatologist—have to have a good working relationship and understanding of the possibilities, both good and bad. Consult with your physician if you plan on having a pregnancy.
Comments
I was diagnosed with APS in 2005 after 4 miscarriages. My OB/GYN had me inject Heparin (blood thinner) 2x a day through out my 5th pregnancy, starting at 5 weeks. It was successful! I carried a beautiful baby boy to term and delivered via planned c-section. I went on to have another baby 3 yrs later. Instead of Heparin, this time I injected Lovenox 1x a day. Again, it was successful! I carried a beautiful baby girl to term and delivered via c-section once again.
Hi,
Q.. How about if I am allergic to heparin?
Sara, thank you for your question. Dr. Michael Lockshin says, “If you are truly allergic to heparin—it is rare, but does happen—there are other forms of anticoagulants, for instance fondaparinux, that can be used. There is less experience with these other drugs in pregnancy, and from a theoretical point of view heparin should work better. Another way of managing a pregnancy if heparin cannot be used might be intravenous immunoglobulin. For all of these things you need doctors with a lot of experience to guide you.”
I am seventeen and I have been diagnosed with APS. My doctors have told me that pregnancy will be difficult but doable, and I have always looked forward to having children. I take 40mg of Lovenox injected once a day. My question is; would it be easier to carry out a pregnancy in my early twenties instead of waiting longer? Would my chances of carrying a baby to term be greater if I tried at a younger age than I had planned? I am in a stable relationship and plan to marry my boyfriend of two years shortly after we turn 21 or so, so I don”t have any worries about our relationship.
Hi Tari, Thanks for reaching out. HSS rheumatologist Dr. Lisa Sammaritano says, “Your age doesn’t affect the risk of miscarriage or pregnancy outcome in APS. Your doctor can discuss the details in terms of what medications might be indicated for you during pregnancy; it depends on your medical history and can vary between patients.”
My daughter-in-law was diagnosed with this syndrome after 3 miscarriages,(although I do not know the severity of it),she was instructed to take one baby aspirin per day. She very quickly became pregnant but then had a 4th miscarriage within 2 – 3 wks. In your professional opinion & experience would you recommend she be on Heparin or Lovenox instead of the baby aspirin?
Hi Janyce – Thanks for reaching out. We recommend that your daughter consult with her treating physician. If you’d like to speak with a physician who researches and treats patients with this condition, please contact our Physician Referral Service at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp.
Why can Antiphospholipid Syndrome lead to premature births?
Great question. HSS rheumatologist Dr. Lisa Sammaritano says, “Antiphospholipid antibodies predispose to blood clot formation, which can lead to the placenta not working properly to deliver nutrients to the developing baby. However, these antibodies work through other mechanisms as well, so we do not always see clear evidence of blood clots in the placenta of a failed or complicated pregnancy. There are medication that can thin the blood and inhibit some of the antibodies’ other actions. This treatment can prolong pregnancy and prevent miscarriage for patients with APS. Its important to consult with a physician on what approach is best for you.” Learn more about APS at http://www.hss.edu/condition-list_antiphospholipid-syndrome.asp
My wife had three miscarriages in the past. We did all the necessary test (Antibodies, IgG, IgM, Antiphospolipid, Lupus and finally chromosome). Doctors could not find any reasons why she had miscarriages. During the last three pregnancies, she had very similar symptoms….that is bleeding in 7th or 8th week, blood clots (large) in her uterus for the weeks up to 17th week. Doctors treated her with Susten (Progesterone injection) and HCG injection. Also all the three times we had to force the pregnancy to happen. She was treated with Fertibex Tablet to get conceived. I am unable to understand why is she experiencing repeated pregnancy loss. Also could not understand the results of APS test. and it is normal when we tested after her pregnancy loss. Doctors, I think, do not know when to perform this test? Is that during her pregnancy or after the pregnancy loss or before the pregnancy? Can someone answer my questions?
Thanks for your question. We’re sorry to hear about your and your wife’s struggles. Rheumatologist Dr. Jane Salmon said, “There are many causes of miscarriages, and unfortunately in about one-third of patients who miscarry, we don’t know why. High levels of antiphospholipid antibodies are associated with miscarriages in some patients, but most of these patients do fine.” We recommend you speak with your wife’s physicians about her test results and your concerns. If you would like to make an appointment with an HSS physician, please contact our Patient Referral Service at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp.
Do you normally recommend planning the delivery date ahead of time, or letting nature take it”s course? I”m 8 months pregnant with APS, and had 2 clots in my life. I”m concerned that letting nature take it”s course is too risky since I don”t know when the baby will come in relation to when I take heparin, so maybe a planned induction or a C-section would be safer?
Hi Jamie – Congratulations on your pregnancy. Rheumatologist Dr. Jane Salmon says, “Given that you had clots and are receiving heparin to prevent pregnancy-associated clots, it is best to schedule your delivery. If you are on low molecular weight heparin (lovenox) you can be transitioned to unfractionated heparin near term and labor can be induced if there is no other reason for a C-section.” It is best to consult with your treating physician.
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Hi Mimi – Thanks for reaching out. We’re glad you learned something from this post. Let us know if you have any questions.
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My first pregnancy was a normal one but delivered with c-section. I was diagnosed with APS after 2 miscarriages after first pregnancy. Had to inject myself with Clixane for the 3rd pregnancy until delivering the baby with c-section. i would like to know if i can still have baby number 3. I really want to try for number 3 now.
Thanks for reaching out. Rheumatologist Dr. Michael Lockshin says, “Thanks for the question. I would need much more information about you to offer an accurate answer to your question, but, in general, if your last pregnancy under treatment with low molecular weight heparin (Clixane) was successful, and, presuming you don”t have other medical concerns such a kidney or heart disease, a subsequent pregnancy should be successful. Whether you will need another Caesarean section will depend on the obstetrical criteria for operative delivery at the time of delivery.” Please consult with your physician regarding this question or any other concerns.
I am 25 years old, and I was recently diagnosed with APS after having a stroke. In a previous pregnancy I suffered from preeclampsia and lost my son at 26 weeks. Could the APS and preeclampsia be related in any way? Could a pregnancy with APS and history of preeclampsia be successful, or am I asking for trouble?
Hi Emily, We’re sorry to hear about your troubles. Rheumatologist Dr. Michael Lockshin says, “You asked two questions. The first is whether a pregnancy with APS and prior preeclampsia can be successful, and the answer is yes. Depending on your specific circumstances – your blood pressure, your kidney function, and many other things including how you are treated during a subsequent pregnancy – the risk of recurrence can be as low as 25%. The second question is whether you are asking for trouble, and the answer to that is a pregnancy leads you into the unknown, so if your personal safety is the highest priority you are safer nonpregnant than pregnant. I have seen different people choose their priorities in different ways. If you are local, we will be pleased to evaluate you here to give a more precise prediction.” To make an appointment with an HSS physician, please contact our Physician Referral Service at +1.877.606.1555 or https://www.hss.edu/secure/prs-appointment-request.asp?pageid=6463. Wishing you the best.
Hi.
I have APS & its been a yr. Since my diagnosis & lost my
Son. I was wondering if stress is a big factor, age & weight? Do these things make it worst?
Thanks for reaching out. We’re sorry to hear you’re having trouble. Rheumatologist Dr. Jane Salmon says, “The brain and stress can influence the immune system, but its effect on APS is not clear. Obesity creates an inflammatory state and this may alter severity of disease, again, it is not known specifically how it affects APS.” Please consult with your physician with any questions. If you’d like to make an appointment with an HSS physician, contact our Physician Referral Service at +1.877.606.1555 or https://www.hss.edu/secure/prs-appointment-request.asp?pageid=6463.
Hi. Is there a link between HELLPs and APS?
My first pregnancy I developed HELLPs and delivered at 30 weeks. My son, now three, is healthy and wonderful and we are thinking of having another one. I was recently diagnosed with lupas anticoagulant and wonder if this cause my complications in my first pregnancy? And with treatment for APS can I avoid these complications a second time around?
Hi Tifanie, Thanks for your question. Rheumatologist Dr. Jane Salmon says, “Patients with APS are more likely to get preeclampsia, and HELLP is severe form of preeclampsia. Although there are no studies to prove that anticoagulants will prevent a recurrence of preeclampsia, given the seriousness of HELLP it is important to intervene with treatments for APS and to have very close monitoring by your obstetrician.” It is best to consult with your physician on any concerns.