AB0581 Pregnancy outcomes in women with antiphospholipid syndrome and thrombophilia treated in a multidisciplinary unit
Authors: I. Añón Oñate, M.Á. Ferrer González, L. Pérez Albaladejo, I. Notario Ferreira, M. Ramírez de la Torre, S. Quirosa Flores, A. García Sánchez, M.C. Ramírez Barberena, J.M. Andreu Ubero, R. Cáliz Cáliz
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The Antiphospholipid Syndrome (APS) and Thrombophilia predominantly affect women of fertile age, so their pregnancies should be considered high obstetric risk. These pregnant women need close monitoring in a multidisciplinary unit. <h3>Objectives</h3> To evaluate the efficacy of the treatment on the pregnancy outcomes of women with APS and thrombophilia from a Spanish cohort. <h3>Methods</h3> Descriptive, prospective, longitudinal and open study of 88 pregnant patients with primary and/or secondary APS and thrombophilia assisted in a specialised multidisciplinary unit of Rheumatic Diseases and pregnancy (integrated by Gynaecologists, Haematologists and Rheumatologists). The following variables were collected: age, maternal pathology, presence of antiphospholipid antibodies, thrombotic episodes and prior abortions, number of childbirths, treatment during pregnancy, obstetric outcomes births/abortion and pregnancy length and maternal/fetal complications. <h3>Results</h3> 88 pregnant women were included in the study. 44 patients were diagnosed with thrombophilia (mostly, Heterozygotes for MTHFR gene), 33 with primary or secondary APS and 11 patients were diagnosed with both APS and thrombophilia. 140 pregnancies were developed during the monitoring: 61% of women had a single birth, 30% had two births and 5% had three births. Abortions registered before and during inclusion in our unit are specified in figure 1. Before the inclusion in our unit, 52% patients had 1 or 2 abortions, 25% had 3 abortions and 23% had 4 or more abortions. 10% patients had presented a previous thrombosis. Our patients were an average of 33.6±5.5 years old and the 44.3% were elder than 35 years. Among the 44 patients with APS: 50% presented positivity to Lupus Anticoagulant (LA), 25% had triple positive antiphospholipid antibodies (LA, anticardiolipin antibodies and anti-ß2-glycoprotein) and 27% had double positive autoantibodies. As for the treatment received during the 140 pregnancies: 50% pregnant women received treatment with prophylactic doses of low-molecular-weight heparin (LMWH) together with acetylsalicylic acid (ASA), 26% were treated in monotherapy with LMWH and 9% in monotherapy with ASA. 10 patients diagnosed with thrombophilia, with an average of 5.3±1.5 abortions per patients, received treatment with LMWH, ASA and intravenous gammaglobulin. All patients who received LMWH during pregnancy also received LMWH after birth for 6 weeks. The mean gestational age was 38 weeks with an average birth weight of 3058.5±595.6 grams. 13% babies were preterm and 32% births were caesarean. 87% of our patients did not have complications in the puerperium. <h3>Conclusions</h3> The treatment is effective in the prevention of abortions. Our results demonstrate a decrease in the number of abortions and a larger number of term pregnancies since the inclusion of patients with high risk pregnancies in our unit. The multidisciplinary evaluation is essential to prevent complications in women diagnosed with APS and thrombophilia in order to reduce adverse pregnancy outcomes and exacerbations of the mother's pathology. <h3>Disclosure of Interest</h3> None declared