Background/Purpose: The goal of this long-term project was to investigate the course of pregnancy in patients with APS (primary or secondary with SLE) in 1993-2017, to describe the type and severity of it and to explore their relationship with disease-related characteristics. To find specific histological changes in maternal tissue in a subgroup of patients.

Methods: During more than 25 years of systematic observation 80 pregnant women with APS were observed and examined. Secondary APS was in our cohort common with systemic lupus erythematosus (SLE). Patients were evaluated every 3 months by a rheumatologist and gynaecologist. Basic demographic data were assessed, as well as the duration and type of therapy, autoantibodies, organ involvement and its activity, the number and type of disease flares, thrombosis, the number of abortions and premature labours, new-born weight and presence of complications such as gestational diabetes, hypertension and preeclampsia. In a subgroup of 13 patients (5 with primary APS, 7 with sec.APS/SLE a macroscopic and histological examination of maternal tissue was performed in comparison with a healthy control group.

Results: The group comprised 65 pregnant women with APS, out of which 57% had secondary APS/SLE and 33% primary APS. In the group of primary APS 90% pts were treated with low molecular heparin and/or salicylates. In pts. with sec.APS/SLE 90 % of patients were treated with oral corticosteroids, 8% with cyclosporine A and 16% with azathioprine and 95% with low molecular weight heparin and/or salicylates. 7% of pregnancies were terminated in the first trimester due to missed abortion. 6% of abortions in patients with sec. APS/SLE in second trimester were observed. 57 APS patients delivered 58 newborns, 16% of them before the 37th week of pregnancy and 7% before the 34th week. Out of this group 75% patients delivered prematurely due to hypertension or preeclampsia, 10% due to growth retardation of fetus. Newborn weight was 3020g on average. AV heart block of 3rd degree was observed in 1 newborn with sec.APS/SLE. No congenital malformations were observed in our group. In the group sec.APS/SLE higher number of gestational diabetes was found: 38% of patients, all of which were treated with corticosteroids. Hypertension was found in 33% patients, preeclampsia in 12 % and 60% of patients with preeclampsia had a history of lupus nephritis. Higher score of maternal infarcts and decidual pathological changes with deposits of immunocomplexes were found in microscopic examination in patients with APS in comparison with healthy controles. Rate of weight placenta/fetus was lower. Signs of accelerate aging, nodules and inflammatory infiltration was found in light microscopy and higher score of deposits of immunecomplexes were found.

Conclusion: In spite of the fact that women with APS have a high risk during the course of pregnancy, the results of our long terms study showed a good outcome of pregnancy. Higher rate of complications was found in the group with sec. APS with SLE.

Supported by Research Project Ministry of Health of Czech Republic NO: 000 000 23728

ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-outcomes-in-a-cohort-of-women-with-antiphospholipid-syndrome-25-years-long-term-observation/