Antiphospholipid Syndrome and Pregnancy Loss: What Every Couple Should Know

06 Jul Antiphospholipid Syndrome and Pregnancy Loss: What Every Couple Should Know

You have lost a pregnancy. Then another. And perhaps another. You have had all the standard tests, and still no one can tell you why. This experience recurrent pregnancy loss without a clear explanation — is one of the most emotionally exhausting things a couple can go through.

What many couples do not know is that antiphospholipid syndrome and pregnancy loss are closely linked — and this condition, once diagnosed, has effective treatment options that may dramatically change outcomes. You deserve answers.

What Is Antiphospholipid Syndrome (APS)?

Antiphospholipid syndrome (APS), also called Hughes syndrome or sticky blood syndrome, is an autoimmune condition in which the immune system produces antibodies that mistakenly attack phospholipids — fats that form the outer membrane of cells. This causes abnormal blood clotting throughout the body, including in the delicate blood vessels of the placenta.

Quick Answer: Antiphospholipid syndrome (APS) is an autoimmune disorder that causes abnormal blood clotting. During pregnancy, APS can cause clots in the placenta, preventing the baby from receiving enough oxygen and nutrients — leading to miscarriage, late pregnancy loss, or stillbirth. APS is diagnosed through blood tests and treated with low-dose aspirin and heparin injections during pregnancy. With treatment, live birth rates may improve significantly.

According to Mayo Clinic, APS is a lifelong condition that requires ongoing treatment and monitoring — but with the right care, many women with APS go on to have healthy pregnancies.

How APS Causes Pregnancy Loss

In pregnancy, the placenta depends on thousands of tiny blood vessels to supply the baby with oxygen and nutrients. When APS antibodies trigger clotting in these vessels, the placenta becomes unable to function properly. This can result in:

• First-trimester miscarriage — the most common presentation (multiple, recurrent)
• Second or third-trimester loss — strongly associated with APS; late loss should always prompt APS testing
• Stillbirth — placental insufficiency in later pregnancy
• Preeclampsia and foetal growth restriction — from impaired placental blood flow

Research published in PMC (Antiphospholipid Syndrome during Pregnancy) notes that untreated APS carries up to an 80% risk of pregnancy loss in affected women — yet with appropriate treatment, outcomes improve significantly.

Who Should Be Tested for APS?

Testing is recommended for women with:

• Two or more unexplained miscarriages at any stage
• One unexplained pregnancy loss after 10 weeks
• History of preeclampsia or severe intrauterine growth restriction
• History of blood clots (deep vein thrombosis, pulmonary embolism) or stroke
• An autoimmune diagnosis such as lupus (SLE)

Diagnosis — What Tests Are Done?

APS is confirmed through blood tests that detect three specific antibodies:

• Lupus anticoagulant (LA)
• Anticardiolipin antibodies (aCL) — IgG and IgM
• Anti-beta-2 glycoprotein I antibodies

For a confirmed APS diagnosis, at least one of these must test positive on two occasions, 12 weeks apart. A single positive result is not sufficient, as these antibodies can sometimes appear temporarily after an infection.

Treatment — How APS Is Managed in Pregnancy

• Low-dose aspirin (75–100mg daily) — started before conception
• Low molecular weight heparin (LMWH) injections — started from a positive pregnancy test and continued throughout pregnancy
• Close monitoring — more frequent scans to assess foetal growth, placental blood flow, and blood pressure

With this treatment, live birth rates in APS patients can improve dramatically — from under 20% untreated to approximately 70–80% with appropriate management. Starting treatment before conception, not after a positive test, is strongly recommended.

APS and IVF

For women with APS undergoing IVF, anticoagulation is typically incorporated into the IVF protocol. Additionally, PGT-A (Preimplantation Genetic Testing for Aneuploidy) may be recommended alongside APS treatment to screen for chromosomal abnormalities in embryos — addressing two potential contributors to pregnancy loss simultaneously.

At Fertibless Clinic, Dr. Shipra Gupta works with each APS patient to design a protocol that combines the right anticoagulation plan with a personalised IVF approach.

Expert Insight — Dr. Shipra Gupta, Fertibless Clinic

“APS is one of the most treatable — and most under-diagnosed — causes of recurrent pregnancy loss. In my experience, many women arrive at Fertibless after two or three losses having never been tested for antiphospholipid antibodies. A full thrombophilia screen is now a standard part of our recurrent loss evaluation. Finding APS is not frightening — it is a relief, because it means we have a clear treatment plan.”

— Dr. Shipra Gupta, Gynaecologist & Infertility Specialist, Fertibless Clinic, New Delhi

Frequently Asked Questions