Antiphospholipid syndrome (APS) is a multisystemic autoimmune disorder. It is the most common autoimmune disorder associated with early recurrent pregnancy losses or miscarriages

APS is also called Hughes Syndrome, named after the person who did a lot of work to bring to light APS.

We will delve into the discussion of antiphospholipid syndrome in pregnancy and recurrent pregnancy losses to give you a better understanding of the disease.

In this post, we will share briefly on recurrent pregnancy loss and give in-depth information on APS:

    • cause
    • symptoms and complications
    • how a diagnosis is made including the tests involved
    • available treatment

What is Recurrent Pregnancy Loss

Recurrent pregnancy loss refers to repeat pregnancy losses or spontaneous recurrent miscarriages of 2 or more consecutive pregnancy losses at or before 20 weeks gestation and is a devastating event to many couples. About 5 out of 100 couples have recurrent miscarriages. Losing a pregnancy is devastating and to have two or three miscarriages is very disheartening.

 APS accounts for 5 to 20 out of 100 of the recurrent miscarriages.

Causes of Recurrent Pregnancy Loss

Causes of Recurrent Pregnancy Loss

Only half of the causes of RPL are identified upon investigation. Identified causes and risk factors of recurrent miscarriages include; Previous history of pregnancy loss; anatomic or uterine factors such as uterine anomalies, fibroids, cervical insufficiency, uterine adhesions, poor endometrial receptivity, and adenomyosis; Chromosomal abnormalities affecting the number or structure of chromosomes in the embryos/fetuses; Endocrine disorders such as poorly controlled Diabetes, thyroid disorders, high prolactin levels (hyperprolactinemia), polycystic ovarian syndrome (PCOS), and luteal phase defects; Immunological factors such as antiphospholipid syndrome; Other causes; stress, environmental toxins, alcohol use, smoking obesity, caffeine consumption; Men with excess abnormal sperms or advanced paternal age ; Advanced maternal age is a risk factor too

Antiphospholipid Syndrome

Antiphospholipid syndrome is an immune disorder whereby the body's immune system which normally protects the body against infection and diseases, mounts an immune response by producing antiphospholipid antibodies against some fats in cells called phospholipids or phospholipid-protein complexes and phospholipid binding proteins like beta 2 glycoprotein 1. The body's immune system fights against itself.

  • The cells of the body that are attacked include cells lining the blood vessels, cells lining the inner-most layer of the uterus, platelets, monocytes and decidual cells. The complement system, coagulation factors and inflammatory mediators are involved too
  • The antiphospholipid antibodies activate the cells, coagulation factors and inflammatory mediators to cause clot formation in vessels-veins and arteries and also cause inflammation. This is one of the mechanisms of the pathogenesis of this disorder.
  • As a result, blood clots can occur in different vessels such as in the brain, lungs, legs and placental insufficiency


Prevalence and Epidemiology of APS

Women are the most affected by APS

Classification and Types of Antiphospholipid Syndrome

APS Can be classified as primary whereby there is no other associated autoimmune disorder such as systemic lupus erythematosus (SLE) or secondary APS, in which case there is another autoimmune disorder such as SLE. 4 out of 10 women with SLE have APS and 60% of the patients with lupus and positive lupus anticoagulant are likely to develop APS on follow up in the future.

The clinical types are:

      • The thrombotic type with a history of blood clots
      • Obstetric APS with a history of pregnancy-related complication or morbidity.

Causes and Risk Factors

There is a genetic predisposition which requires environmental factors for APS to manifest clinically. This is the two-hit hypothesis in which case the antiphospholipids (APLs) induce a thrombophilic state-tendency to have blood clotting and the second hit is the environmental exposure that triggers thrombosis or inflammation to occur. This may explain asymptomatic APS.

Environmental risk factors that trigger APS are

    • Pregnancy
    • Immobilization
    • Surgery
    • Cigarette smoking and alcohol use
    • Infection
    • Obesity or Overweight
    • Use of oral contraceptive pills and hormonal replacement therapy in menopause
    • Other inflammatory stimulants for thrombosis
    • Previous history of unexplained pregnancy loss
    • Antiphospholipid antibodies profile
    • History of vascular thrombosis

Symptoms and Complications

The clinical manifestations of the disorder will depend on the location of the blood clots.

  • Thrombotic Complications: Deep Venous Thrombosis-clots in the deep veins of the legs; Pulmonary Thromboembolism-Clot in the pulmonary arteries leading to difficulty in breathing or breathlessness, chest pain; Transient ischemic attack or ischemic attack/stroke.
  • The pregnancy-related complications-unexplained early recurrent pregnancy losses of 3 or more pregnancies less than 10 weeks gestation; One or more pregnancy losses of more than 10 weeks gestation of morphologically normal pregnancies; stillbirths of pregnancy less than 34 weeks gestation due to high blood pressure in pregnancy (severe preeclampsia or eclampsia); placental insufficiency manifesting as preterm births, intra-uterine growth restriction and low birth weight babies; HELLP-Hemolytic _Elevated Liver function tests_ Low Platelet Syndrome
  • Unexplained thrombocytopenia (low platelets).
  • Catastrophic APS is the severest form of APS. This can occur in 1% of women after delivery-puerperium
  • Nervous system manifestations
  • Cutaneous manifestations
  • Asymptomatic carriers

Clinical and Laboratory Criteria for Diagnosis of APS

The presence of antiphospholipid antibodies alone is not enough to make a diagnosis of antiphospholipid syndrome.

History of either a thrombotic event or a pregnancy-related complication combined with the presence of at least one of the laboratory criteria is required for diagnosis of APS.

Laboratory Criteria

Three APLs are tested on two occasions 12 weeks apart;

    • Lupus Anticoagulant-positivity
    • Anticardiolipin antibodies (ACA) for medium to high titers
    • Anti beta 2 Glycoprotein 1 antibodies (IgG and IgM)

Your doctor will take a history from you and examine you before sending you to the laboratory for testing.

Treatment of APS

Can APS be cured

APS is a chronic condition with available treatment to reduce the chances of clot formation. Support groups are key to assist in coping with APS

Can you have a baby with APS?

Up to 7 out of 10 women with APS have successful pregnancy outcomes with standard-of-care treatment for APS. Low molecular weight heparin together with low-dose aspirin starting from conception is considered the standard of care. Talk to your doctor about treatment and usually a multidisciplinary approach to treatment is recommended. A Rheumatologist, physician, haematologist, or maternal medicine specialist may be involved in your care especially where there is a secondary APS or thrombotic type of APS.

Several women may need the addition of other treatments to be able to have a healthy pregnancy.

New Perspectives and Advancements

A lot of research is underway to manage patients with the non-criteria or non-conventional APL antibodies and improve the obstetric outcomes and the results are promising.

    • Newer treatment modalities are in the pipeline with good results demonstrated in cases not responding to conventional or standard-of-care treatment and high-risk patients. These require just a bit more robust research and you can be certain that the guidelines will be updated as soon as the results are out.
    • Research is also underway to find a valuable tool (Global APS Score and adjusted GAPSS) to predict pregnancy outcomes based on risk scoring.
    • Better laboratory assays and whether there is a need to expand the laboratory criteria and include more APLs or even consider 6-12 weeks apart between the tests. Some patients have negative laboratory tests yet have the clinical manifestations of APS-Seronegative APS repeated severally
    • This is because there are patients who do not strictly meet the criteria for diagnosis but have responded very well to treatment with similar pregnancy outcomes as those who meet the criteria.


Can you have APS yet you do not meet the set criteria?

Yes. Some non-criteria manifestations of APS have been identified in both the clinical criteria and laboratory criteria. They include having 2 unexplained recurrent miscarriages; a history of three early recurrent miscarriages that are not consecutive; placental abruption and late preterm birth beyond 34 weeks gestation; low titres of anticardilolipin and anti Beta 2 Glycoprotein 1 and detection of APL antibodies 6-12 weeks apart. 


Screening may be offered to those who have had unexplained recurrent miscarriages and unprovoked proximal DVT or other unprovoked thrombotic events like pulmonary embolism or ischemic stroke. Talk to your doctor to explore the possibility of getting a screen.

Preconception Counselling

Preconception counselling will help with the identification of medications that you are on that may be teratogenic to the baby such as warfarin for those who may be on the same for prior thrombotic event. C

Pregnancy Monitoring

Pregnancy with APS is considered a high-risk pregnancy with closer follow-up needed since the risk of suffering from placental insufficiency is high with its attendant complications. For instance, there will be monthly ultrasound scanning to check the fetal well being et cetra


Copper IUD which is a non-hormonal contraceptive method is the recommended contraceptive.

Fertility and Assisted Reproduction

Patients with APS respond to ovulation drugs and In-Vitro-Fertilization (IVF) as the general population with 30% probability of a successful pregnancy.



  • I have observed that many patients with little income are not able to afford the costs of laboratory tests which remain prohibitive.
  • Treatment with low molecular weight heparin is the recommended treatment modality yet most patients are not able to access the daily or twice daily injections due to cost constraints.
  • Some patients with recurrent pregnancy loss are so mentally drained and need a lot of counselling to be in a better place, yet they may not seek help as they may feel that society may frown upon them. More support groups for these patients are needed.
  • Some of these patients may not be so keen on follow-up and they could do better by going for checkups with their doctors and gynecologists.

Talk to your doctor about recurrent pregnancy loss and the possible causes including APS. The success rate of a good pregnancy outcome is 70% and you stand a chance; do not give up and seek plenty of psychological support from your partner/relatives/friends and professional counselling services as required. Ultimately, the giver of life will work his magic, keep the faith.



  1. Rodriguez-Garcia JL, Bertolaccini ML, Cuadrado MJ, Sanna G, Ateka-Barrutia O, Khamashta MA. Clinical manifestations of antiphospholipid syndrome (APS) with and without antiphospholipid antibodies (the so-called ‘seronegative APS’). Ann Rheum Dis. 2012 Feb;71(2):242-4. doi: 10.1136/annrheumdis-2011-200614. Epub 2011 Sep 27. PMID: 21953349.
  2. Conti F, Andreoli L, Crisafulli F, Mancuso S, Truglia S, Tektonidou MG. Does seronegative obstetric APS exist? “pro” and “cons”. Autoimmun Rev. 2019 Dec;18(12):102407. doi: 10.1016/j.autrev.2019.102407. Epub 2019 Oct 19. PMID: 31639518.
  3. Saccone G, Berghella V, Maruotti GM, Ghi T, Rizzo G, Simonazzi G, Rizzo N, Facchinetti F, Dall’Asta A, Visentin S, Sarno L, Xodo S, Bernabini D, Monari F, Roman A, Eke AC, Hoxha A, Ruffatti A, Schuit E, Martinelli P; PREGNANTS (PREGNancy in women with ANTiphospholipid Syndrome) working group. Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome: the PREGNANTS study. Am J Obstet Gynecol. 2017 May;216(5):525.e1-525.e12. doi: 10.1016/j.ajog.2017.01.026. Epub 2017 Jan 30. PMID: 28153662.
  5. RADU, A., DUDU, S. C., CIOBANU, A., PELTECU, G., IANCU, G., BOTEZATU, R., GICA, N., & PANAITESCU, M. (2019). Pregnancy Management in Women with Antiphospholidic Syndrome. MæDica, 14(2), 148-160.

Address and Contacts

Call Us


Email Us

Our Location

JemPark Complex building suite A5 in Sabaki

Sign Up To Our Newsletter

Please enable JavaScript in your browser to complete this form.
Share This

Share This

Share this post with your friends!