PB0479 - Antiphospholipid Syndrome (APS) in pregnancy: an update of pregnancy management, maternal and perinatal outcome in one Public Hospital in Argentina

Background: The APS is a non-inflammatory autoimmune disease characterized by the presence of antiphospholipid antibodies (aPL) in the plasma of patients with venous and/or arterial thrombosis and/or recurrent complications of pregnancy. Data in support of the association of aPL and obstetric morbidity and the lack of evidence of the benefit of treatment continues to be controversial.

Aims: to describe pregnancy management, maternal and perinatal outcome of patients with APS. Period 2010-2023

Methods: 41 pregnancies in 33 patients fulfilled the Classification Criteria: 1. Thrombotic: 1; 2. Pregnancy morbidity (27): 2a fetal death( FD): 14, 2b severe preeclampsia (sPE) or placental insufficiency (PI): 10 and 2c recurrent early miscarriages (REM):3. Thrombotic and obstetric: 5.
Laboratory categories: I:14 (6 double and 8 triple positivity); IIa: 18 only lupus anticoagulant (LA); II b: 1.
Treatment: enoxaparin 40 mg /d or intermediate and therapeutic in those with thrombotic APS with low dose aspirin (LDA).

Results: 34 newborns, 2 FD (24 and 33 weeks), 2 early abortion, 5 neonatal death in women with previous sPE or PI, one recurrent thrombosis . One pregnancy ongoing. The poorest outcome was observed in women with triple positivity and previous sPE and PI.

Conclusion(s): Patients with previous FD and REM had the best outcome after treatment with heparin and aspirin. Those with previous sPE or PI showed the worst outcome with either fetal or neonatal death. Patients at highest risk were those with triple positivity and/or history of thrombosis. Women with prior late events are at higher risk for an adverse late outcome in a subsequent pregnancy. If the standard regimen is effective in late events and/or high-risk patients need to be confirmed. The emerging interplay between presenting pregnancy complications and response to treatment highlights the urgent need to better define therapeutic options according to the aPL profile and clinical subset.