Rheumatology and Clinical Immunology Unit - ERN ReCONNET, ASST Spedali Civili; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Department of Obstetrics and Gynaecology, ASST Spedali Civili, Brescia, Italy.
Rheumatology (Oxford). 2024 Feb 6;63(SI):SI86-SI95. doi: 10.1093/rheumatology/kead537.
This review focuses on the management of reproductive issues in women who have antiphospholipid syndrome (APS) or are carriers of antiphospholipid antibodies (aPL). The importance of aPL detection during preconception counselling relies on their pathogenic potential for placental insufficiency and related obstetric complications. The risk of adverse pregnancy outcomes can be minimized by individualized risk stratification and tailored treatment aimed at preventing placental insufficiency. Combination therapy of low-dose acetylsalicylic acid and heparin is the mainstay of prophylaxis during pregnancy; immunomodulation, especially with hydroxychloroquine, should be considered in refractory cases. Supplementary ultrasound surveillance is useful to detect fetal growth restriction and correctly tailor the time of delivery. The individual aPL profile must be considered in the stratification of thrombotic risk, such as during assisted reproduction techniques requiring hormonal ovarian stimulation or during the follow-up after pregnancy in order to prevent the first vascular event.
这篇综述重点介绍了患有抗磷脂综合征（APS）或携带抗磷脂抗体（aPL）的女性的生殖问题管理。在孕前咨询期间检测 aPL 的重要性在于其对胎盘功能不全和相关产科并发症的致病潜力。通过个体化风险分层和旨在预防胎盘功能不全的针对性治疗，可以最大限度地降低不良妊娠结局的风险。小剂量乙酰水杨酸和肝素联合治疗是妊娠期间预防的主要方法；对于难治性病例，应考虑免疫调节治疗，特别是羟氯喹。补充超声监测有助于检测胎儿生长受限，并正确调整分娩时间。在分层血栓形成风险时，如需要激素卵巢刺激的辅助生殖技术或妊娠后随访期间，必须考虑个体的 aPL 谱，以预防首次血管事件。
