ANTIPHOSPHOLIPID SYNDROME (D ERKAN, SECTION EDITOR) Pregnancy Morbidity in Antiphospholipid Syndrome: What Is the Impact of Treatment? Guilherme R. de Jesús & Gustavo Rodrigues & Nilson R. de Jesús & Roger A. Levy # Springer Science+Business Media New York 2014 Abstract Women with persistently circulating antiphospholipid antibodies (aPL) have a higher incidence of recurrent abortions, fetal losses, pre-eclampsia, and placental insufficiency. Current treatment of patients with antiphospholipid syndrome (APS) during pregnancy with heparin and aspirin can act by preventing clot formation and improving live birth rates, but other obstetric morbidities remain high, especially in patients with a history of thrombotic events. In addition to the classical thrombotic placental events, other factors involving inflammation and complement activa- tion seem to play a role in certain complications. In this article, we will review how medications interfere in the pathogenic mechanisms of APS, discuss the impact of current recom- mended treatment on pregnancy morbidity, and analyze new promising therapies. Keywords Antiphospholipid syndrome . APS . Obstetric APS . Obstetric antiphospholipid syndrome . Pre-eclampsia . Intrauterine growth restriction . Prematurity . Treatment . Abortion . Pregnancy loss . Fetal death . Heparin . Aspirin . Complement activation . Thrombosis . Hydroxychloroquine . Eculizumab Introduction Pregnancy morbidity is a well-recognized presentation of antiphospholipid syndrome (APS), which is part of the clas- sification criteria [1]. Women with persistent antiphospholipid antibodies (aPL) have a higher incidence of recurrent abor- tions, fetal losses, pre-eclampsia, and placental insufficiency than the general population [2••]. Lately, there have been reports of the pregnancy complications differing between patients with thrombotic or obstetric APS. After appropriate diagnosis, treatment of patients with APS shows remarkable improvement in live birth rates, but the risk of other obstetric morbidities, such as pre-eclampsia, intrauterine growth re- striction (IUGR), and prematurity, remains high. In this article, we will review how medications interfere in the pathogenic mechanisms of APS, discuss the impact of This article is part of the Topical Collection on Antiphospholipid Syndrome G. R. de Jesús : G. Rodrigues : N. R. de Jesús Department of Obstetrics, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil G. Rodrigues e-mail: gustavo1rodrigues@gmail.com N. R. de Jesús e-mail: nilsonrjesus@gmail.com R. A. Levy Department of Rheumatology, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil e-mail: roger.a.levy@gmail.com R. A. Levy Federico Foundation, Vaduz, Liechtenstein G. R. de Jesús (*) 500 Av Prof. Manoel de Abreu, 1st floor, Medicina Fetal, Rio de Janeiro, RJ, Brazil ZIP: 20551-030 e-mail: guilhermedejesus@gmail.com G. Rodrigues 1250 Estrada Benvindo de Novais 202, Recreio, RJ, Brazil N. R. de Jesús 131 Jorge Rudge street, apt 506 bl 1, Vila Isabel, Rio de Janeiro, RJ, Brazil ZIP: 20550-220 R. A. Levy 38 Anita Garibaldi street, 101, Copacabana, Rio de Janeiro, RJ, Brazil ZIP: 22041-080 Curr Rheumatol Rep (2014) 16:403 DOI 10.1007/s11926-013-0403-6