Effects of Maternal Antiphospholipid Syndrome on Offspring Outcomes: A Literature Review

Background: Antiphospholipid Syndrome (APS) is an autoimmune disorder characterized by pregnancy morbidity and/or thrombosis, associated with positivity for antiphospholipid antibodies (aPL). Despite its relative rarity, because it usually affects women of fertile age, and consequentially their offspring, its knowledge remains essential for any neonatologist or pediatrician.

Objective: To review the latest research and perspectives on the outcomes of children born to mothers suffering from APS.

Methods: A search was conducted in the Pubmed® database using the keyword “antiphospholipid syndrome” in combination with any of the following: “pregnancy”, “fetal”, “neonatal”, “pediatric”. Articles were selected considering their pertinence to the subject and relevant references were also reviewed.

Results: Etiology seems multifactorial with multiple genetic and environmental factors likely to play a part. General expert opinion is that these children do not show a significantly increased risk of APS.

A higher frequency of pregnancy complications in APS gravidas such as pre-eclampsia and placental insufficiency (among others) leads to a higher prevalence of prematurity and all its associated complications.

Transplacental passage of aPL is frequent, but its clinical significance remains uncertain and passively transferred aPL levels usually decrease in the first months of life. Early age thrombosis associated with aPL (neonatal/pediatric APS) is extremely rare in these patients - prospective studies found no such episodes in these children’s first years of life. Research focused on thrombosis in aPL+ newborns describes that, in most cases, other maternal or neonatal prothrombotic factors can be found.

Several recent prospective studies show a higher prevalence of neurodevelopmental abnormalities – this is compatible with previous experimental studies on animal models.

Conclusion: Despite appropriate treatment, in maternal APS, pregnancy complications still lead to prematurity and higher rates of poor neonatal outcomes. aPL alone are not sufficient for thrombosis development in neonates. Neurodevelopmental screenings should be considered in these patients’ follow-up schedule.