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Autoimmun Rev. 2014 Aug;13(8):795-813. doi: 10.1016/j.autrev.2014.02.003. Epub 2014 Mar 17.

14th International Congress on Antiphospholipid Antibodies Task Force report on obstetric antiphospholipid syndrome.

Author information

1
Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: guilhermedejesus@gmail.com.
2
The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
3
Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
4
Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, Spedali Civili, University of Brescia, Brescia, Italy.
5
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Immunorheumatological Research Laboratory, Istituto Auxologico Italiano, Milan, Italy.
6
Department of Obstetrics and Gynecology, University of UT, Salt Lake City, USA; Intermountain Healthcare, Salt Lake City, USA.
7
Hospital For Special Surgery, Weill Cornell Medical College, NY, USA; Kirkland Center for Lupus Research, NY, USA; Lupus and APS Center of Excellence, NY, USA.
8
Department of Obstetrics and Gynecology, University of UT, Salt Lake City, USA.

Abstract

Pregnancy morbidity is one of the clinical manifestations used for classification criteria of antiphospholipid syndrome (APS). During the 14th International Congress on Antiphospholipid Antibodies (aPL), a Task Force with internationally-known experts was created to carry out a critical appraisal of the literature available regarding the association of aPL with obstetric manifestations present in actual classification criteria (recurrent early miscarriage, fetal death, preeclampsia and placental insufficiency) and the quality of the evidence that treatment(s) provide benefit in terms of avoiding recurrent adverse obstetric outcomes. The association of infertility with aPL and the effectiveness of the treatment of patients with infertility and positive aPL was also investigated. This report presents current knowledge and limitations of published studies regarding pregnancy morbidity, infertility and aPL, identifying areas that need better investigative efforts and proposing how critical flaws could be avoided in future studies, as suggested by participants of the Task Force. Except for fetal death, there are limitations in the quality of the data supporting the association of aPL with obstetric complications included in the current APS classification criteria. Recommended treatments for all pregnancy morbidity associated to APS also lack well-designed studies to confirm its efficacy. APL does not seem to be associated with infertility and treatment does not improve the outcomes in infertile patients with aPL. In another section of the Task Force, Dr. Jane Salmon reviewed complement-mediated inflammation in reproductive failure in APS, considering new therapeutic targets to obstetric APS (Ob APS).

KEYWORDS:

Antiphospholipid syndrome; Complement; Fetal death; Infertility; Preeclampsia; Recurrent early miscarriage

PMID:
24650941
DOI:
10.1016/j.autrev.2014.02.003
[Indexed for MEDLINE]

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