Management of Pregnancy in Antiphospholipid (Hughes’) Syndrome (APS) - A Guide for Patients
Introduction
Antiphospholipid Syndrome (APS) is an autoimmune disorder that can complicate pregnancy. This leaflet provides information on managing pregnancy with APS to help ensure a healthy outcome for both mother and baby.
What is Antiphospholipid Syndrome (APS)?
APS is a condition where the immune system produces antibodies that increase the risk of blood clots. In pregnancy, APS can lead to complications such as miscarriage, stillbirth, preeclampsia, and premature birth.
Goals of Management During Pregnancy
The primary goals of managing APS during pregnancy:
Pre-Pregnancy Planning
Prevent pregnancy complications.
Ensure the health and safety of both mother and baby.
Consultation with Healthcare Providers
Before becoming pregnant, it is important to consult with healthcare providers who specialise in APS and high-risk pregnancies. This team should include:
A Rheumatologist
An Haematologist (blood doctor)
An obstetrician (Baby doctor) specializing in high-risk pregnancies (maternal-fetal medicine specialist).
Medication Review
Your healthcare provider will review and adjust your medications to ensure they are safe for pregnancy. Generally, drugs such as Warfarin are stopped once you know you are pregnant because they are not safe after the 6th week of pregnancy and may harm the baby. This involves switching to medications that are safe for both you and your baby.
During Pregnancy
Anticoagulation Therapy
Blood thinners (anticoagulants) are the cornerstone of managing APS during pregnancy. The commonly used anticoagulants include a combination of the following two therapies:
Low-Dose Aspirin: This is recommended for its anti-inflammatory and anticoagulant properties.
Heparin: A type of anticoagulant that is safe to use during pregnancy as it does not cross the placenta. It is usually given as daily self administered injections.
Monitoring
Frequent monitoring is essential to manage APS eSectively during pregnancy. This includes:
Blood Tests: Regular blood tests to monitor the eSectiveness of anticoagulant therapy and check for any side effects.
Ultrasound Scans: To monitor the baby’s growth and development and check for any signs of complications.
Blood Pressure Checks: To monitor for signs of preeclampsia, a condition characterised by high blood pressure.
Lifestyle and Dietary Changes
Adopting a healthy lifestyle can support the management of APS during pregnancy:
Balanced Diet: Eat a diet rich in fruits, vegetables, whole grains, and lean proteins.
Take foods which contain vitamin K sparingly and at the same time each day if you are on warfarin or similar coumarin anticoagulants, as it can affect blood clotting.
Regular Exercise: Engage in moderate physical activity as recommended by your healthcare provider.
Smoking Cessation: Avoid smoking as it increases the risk of blood clots and pregnancy complications.
Delivery Plan
Timing and Method of Delivery
The timing and method of delivery will be planned based on your specific circumstances. Your healthcare team will consider factors such as:
The health of both mother and baby.
The presence of any complications.
The effectiveness of anticoagulant therapy.
Postpartum Care
After delivery, it is important to continue managing APS to prevent postpartum blood clots. This may involve:
Continuing anticoagulant therapy.
Monitoring for any signs of blood clots or bleeding.
Potential Complications and How to Address Them
Miscarriage and Stillbirth
APS can increase the risk of miscarriage and stillbirth. Regular monitoring and appropriate anticoagulant therapy significantly reduce these risks.
Preeclampsia
Preeclampsia is a condition characterised by high blood pressure and protein in the urine. It requires close monitoring and management by your healthcare provider.
Preterm Birth
APS can increase the risk of preterm birth. Your healthcare provider will monitor your pregnancy closely and take necessary steps to manage preterm labor if it occurs.
When to Seek Medical Attention
Seek immediate medical attention if you experience any of the following symptoms:
Severe headache or dizziness.
Sudden swelling of the hands, feet, or face.
Shortness of breath or chest pain.
Severe abdominal pain.
Signs of a blood clot, such as swelling, redness, and pain in the limbs.
Conclusion
Managing APS during pregnancy involves a combination of medication, regular monitoring, and lifestyle adjustments. By working closely with your healthcare team, you can reduce the risk of complications and help ensure a healthy pregnancy and delivery. Always follow your healthcare provider’s advice and attend all scheduled appointments for the best possible outcomes for you and your baby.
Dr. Arvind Kaul on behalf of Hughes APS Trust 2024
This information is provided for educational purposes and must not replace professional medical advice. Always consult your healthcare provider for personalised recommendations and treatments.
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