title: Primary prophylaxis to prevent obstetric complications in asymptomatic women with antiphospholipid antibodies: a systematic review.
abstract: OBJECTIVE
  Obstetric complications are common in patients with antiphospholipid syndrome. However, the impact of antiphosholipid antibodies (aPL) in the pregnancy outcomes of asymptomatic aPL carriers is uncertain. The aim of this systematic review is to assess whether primary prophylaxis is beneficial to prevent obstetric complications during pregnancy in asymptomatic women positive for aPL who have no history of recurrent pregnancy loss or intrauterine fetal death.
  
  
  METHODS
  Studies evaluating the effect of prophylactic treatment versus no treatment in asymptomatic pregnant aPL carriers were identified in an electronic database search. Design, population and outcome homogeneity of studies was assessed and meta-analysis was performed. The pooled Mantel-Haenszel relative risk of specific pregnancy outcomes was obtained using random effects models. Heterogeneity was measured with the I(2) statistic. All analyses were conducted using Review Manager 5.3.
  
  
  RESULTS
  Data from five studies involving 154 pregnancies were included and three studies were meta-analysed. The risk ratio and 95% confidence interval (CI) of live birth rates, preterm birth, low birth weight and overall pregnancy complications in treated and untreated pregnancies were 1.14 (0.18-7.31); 1.71 (0.32-8.98); 0.98 (0.07-13.54) and 2.15 (0.63-7.33),respectively. Results from the meta-analysis revealed that prophylactic treatment with aspirin is not superior to placebo to prevent pregnancy complications in asymptomatic aPL carriers.
  
  
  CONCLUSIONS
  This systematic review did not find evidence of the superiority of prophylactic treatment with aspirin compared to placebo or usual care to prevent unfavourable obstetric outcomes in otherwise healthy women with aPL during the first pregnancy.
authors: Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan olgaam@med.hokudai.ac.jp.
authors: O
authors: O
authors: Amengual
authors: Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki City, Osaka, Japan.
authors: D
authors: D
authors: Fujita
authors: Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
authors: E
authors: E
authors: Ota
authors: Institute for Musculoskeletal Health, Madrid, Spain.
authors: L
authors: L
authors: Carmona
authors: Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: K
authors: K
authors: Oku
authors: Department of Gynaecology, Nagoya City University Hospital, Nagoya, Japan.
authors: M
authors: M
authors: Sugiura-Ogasawara
authors: Department of Rheumatology, Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors: A
authors: A
authors: Murashima
authors: Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: T
authors: T
authors: Atsumi
mesh_terms: D017153:Antibodies, Anticardiolipin / Q000276:immunology*; D017152:Antibodies, Antiphospholipid / Q000276:immunology*; D016736:Antiphospholipid Syndrome / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011322:Primary Prevention / Q000379:methods
chemical_list: D017153:Antibodies, Anticardiolipin; D017152:Antibodies, Antiphospholipid
keywords: Pregnancy morbidity; anticardiolipin antibodies; aspirin; lupus anticoagulant; obstetric outcome