Obstetric Antiphospholipid Syndrome Carries an Increased Lifetime Risk for Obstetric and Thrombotic Complications - a Population-Based Study.

Background Antiphospholipid syndrome (APS) can present with either a thromboembolic event (Thrombotic APS, TAPS) or an obstetric complication (Obstetrics APS, OAPS). Data on long-term complications in the different APS phenotypes are limited. We aimed to compare obstetric history, antiphospholipid antibody profiles, obstetric and thromboembolic complications, and pregnancy outcomes between TAPS and OAPS. Methods This retrospective cohort study included women who delivered singleton pregnancies between 1998-2020. 116,409 women were included, resulting in 320,455 deliveries. Among the included patients, 71 were diagnosed with APS, 49 were classified as OAPS, and 22 as TAPS. The demographics, obstetric, neonatal, and thrombotic outcomes were compared among TAPS, OAPS, and the general obstetric population. Results OAPS patients had an increased risk of thrombotic events compared to the general obstetric population (OR 18.0 (95% CI 8.7-37.2). In pregnancies following the diagnosis of APS, despite standard antithrombotic treatment, OAPS patients exhibited an elevated risk of placenta-related and neonatal complications compared to the general obstetric population (late fetal loss (15.3, 0.5-27.5) stillbirth (5.9, 2.2-15.4), placental abruption (4.8, 1.5-15.3), preeclampsia (4.4, 2.5-7.7), fetal growth restriction (4.3, 8.5-27.5), small for gestational age neonate (4.0, 2.4-6.6), and low Apgar scores (Apgar'1: 2.6, 1.3-10.4, Apgar'5 3.7, 1.3-10.4)). TAPS patients exhibited increased risk of preeclampsia (3.1, 1.2-8). Conclusions OAPS patients exhibit a heightened risk of thrombotic events compared to the general obstetric population. Despite treatment, OAPS and TAPS still presented obstetric complications. These findings, after confirmation in prospective studies, need to be taken into consideration when planning the treatment approach for these patients.