Murvai Viorela Romina, Galiș Radu, Panaitescu Anca, Radu Casandra Maria, Ghitea Timea Claudia, Trif Paula, Onița-Avram Miruna, Vesa Alexandra Alina, Huniadi Anca
Doctoral School of Biological and Biomedical Sciences, Bihor County Emergency Clinical Hospital, University of Oradea, Oradea, 410087, Romania.
Clinics Department, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410073, Romania.
BMC Pregnancy Childbirth. 2025 Mar 24;25(1):337. doi: 10.1186/s12884-025-07471-w.
Antiphospholipid syndrome (APS) is an autoimmune disorder associated with thrombotic events and adverse obstetric outcomes, particularly in its obstetric form (OAPS). Affecting approximately 0.5% of the population, APS is a leading contributor to recurrent pregnancy loss (RPL), preeclampsia (PE), and fetal growth restriction ((FGR). Despite advancements in understanding its pathophysiology and management, optimal treatment strategies for APS in pregnancy remain challenging and require systematic evaluation. This review synthesizes current evidence on APS mechanisms, diagnostic criteria, and therapeutic interventions, with a focus on maternal and fetal outcomes in OAPS.
A comprehensive search of PubMed, was conducted to identify studies exploring APS pathogenesis, diagnostic standards, and treatment efficacy in obstetric settings. Inclusion criteria prioritized randomized controlled trials, cohort studies, and systematic reviews with a clear focus on APS and pregnancy.
The review confirmed that APS current accepted pathogenesis is governed by a "two-hit" model, where antiphospholipid antibodies (aPLs) initiate endothelial damage, culminating in thrombosis and placental insufficiency. Epidemiological analysis underscores the prevalence and severity of APS in obstetric contexts, with lupus anticoagulant (LA) emerging as a significant predictor of adverse outcomes. Evidence supports the use of low-dose aspirin (LDA) and heparin to reduce miscarriage rates, while adjunctive treatments, such as hydroxychloroquine (HCQ), have shown promise in improving live birth rates and reducing preterm delivery in high-risk cases. Emerging therapies, including tumoral necrosis factor (TNF-alpha) inhibitors and nitric oxide modulators, may offer additional benefits in refractory cases.
APS remains a critical determinant of adverse pregnancy outcomes, necessitating precise diagnostic criteria and tailored management approaches. This systematic review emphasizes the importance of individualized therapeutic regimens to optimize maternal and fetal health in OAPS and highlights areas for future research, particularly regarding novel pharmacological approaches. Further studies are essential to refine treatment protocols and improve clinical guidelines for managing APS in pregnancy.
抗磷脂综合征（APS）是一种自身免疫性疾病，与血栓形成事件及不良产科结局相关，尤其是其产科形式（OAPS）。APS影响约0.5%的人群，是复发性流产（RPL）、子痫前期（PE）和胎儿生长受限（FGR）的主要原因。尽管在理解其病理生理学和管理方面取得了进展，但妊娠APS的最佳治疗策略仍然具有挑战性，需要系统评估。本综述综合了关于APS机制、诊断标准和治疗干预的现有证据，重点关注OAPS中的母婴结局。
对PubMed进行全面检索，以识别探索APS在产科环境中的发病机制、诊断标准和治疗效果的研究。纳入标准优先考虑随机对照试验、队列研究和明确关注APS与妊娠的系统评价。
该综述证实，目前公认的APS发病机制由“双打击”模型主导，其中抗磷脂抗体（aPLs）引发内皮损伤，最终导致血栓形成和胎盘功能不全。流行病学分析强调了APS在产科环境中的患病率和严重性，狼疮抗凝物（LA）是不良结局的重要预测指标。有证据支持使用低剂量阿司匹林（LDA）和肝素降低流产率，而辅助治疗，如羟氯喹（HCQ），在改善高危病例的活产率和减少早产方面显示出前景。包括肿瘤坏死因子（TNF-α）抑制剂和一氧化氮调节剂在内的新兴疗法，可能为难治性病例带来额外益处。
APS仍然是不良妊娠结局的关键决定因素，需要精确的诊断标准和量身定制的管理方法。本系统评价强调了个体化治疗方案对优化OAPS中母婴健康的重要性，并突出了未来研究的领域，特别是关于新型药理学方法的研究。进一步的研究对于完善治疗方案和改进妊娠APS管理的临床指南至关重要。
