The Medical Management of Antiphospholipid Syndrome in Pregnancy

Abstract

INTRODUCTION: Controversies exist regarding the optimal medical management of antiphospholipid syndrome in pregnancy to prevent obstetric complications. We therefore conducted a systematic review and meta-analysis to evaluate the effect of different pharmacotherapies on pregnancy outcomes in women with antiphospholipid syndrome. METHODS: We searched the Cochrane Library, EMBASE, and MEDLINE from inception to June 2013. Randomized controlled trials (RCTs) examining the use of pharmacotherapies (aspirin, low-molecular weight heparin [LMWH], unfractionated heparin [UFH], intravenous immunoglobulin) in pregnant women with antiphospholipid syndrome were included. Data were extracted independently by two reviewers. Live birth data were pooled across RCTs using a random-effects model. RESULTS: Sixteen RCTs investigating pregnancy outcomes in women with antiphospholipid syndrome (n=803) were included in our meta-analysis. When data were pooled across RCTs, the combination of aspirin and UFH increased live birth rates compared with aspirin alone (relative risk [RR] 1.54, 95% confidence interval [CI] 1.25–1.89), whereas the combination of aspirin and LMWH resulted in a similar rate as aspirin alone (RR=1.07; 95% CI=0.88; 1.29). However, the combination of aspirin and LMWH did increase live births compared to IVIG (RR 1.64, 95% CI 1.21–2.22). The results of other pairwise comparisons were not statistically significant, although some estimates were accompanied by wide 95% CIs and did not rule out clinically important differences (Fig. 1).CONCLUSIONS: Our meta-analysis suggests that the combination of aspirin and UFH results in a higher live birth rate than aspirin alone, whereas the combination of aspirin and LMWH was superior to intravenous immune globulin.