Obesity and Antiphospholipid Syndrome: A Particular Challenge in Pregnancy

Abstract

Obesity is associated with a broad spectrum of chronic diseases, as well as cardiovascular diseases, such as diabetes, dyslipidemia, insulin resistance and hyperglycemia. Obesity
during pregnancy is of major concern due to the well-known risk factors for both the mother
and the child. Complications in pregnancy include recurrent miscarriages, gestational diabetes, hypertensive disorders, thromboembolism, and stillbirth. Additionally, maternal obesity
seems to have long-term consequences for offspring, predisposing or “programming” them to
the development of metabolic disease in adulthood. Antiphospholipid syndrome (APS) is an
autoimmune disease and is characterized by the presence of antiphospholipid antibodies (anticardiolipin antibodies/ACLA, lupus antikoagulans/LA and ß2-glycoprotein) in the maternal
circulation. These antibodies are associated with arterial and/or venous thromboses and with
adverse obstetric outcomes such as recurrent fetal loss, Preeclampsia (PE), Intrauterine growth
restriction (IUGR) and Intrauterine fetal death (IUFD).
Obesity and APS are both chronic diseases with similar, even long-term consequences
for mother and child; a co-occurrence of obesity and APS in pregnancy worsens the situation;
the use of novel therapeutical tools should be therefore encouraged. A better understanding
of the complex interactions between endothelial dysfunction and obesity and APS should be
further investigated. Obese women with known APS should be counselled before conception
not only about potential obstetrical complications as well as the long-term consequences for the
off-spring, but also about these important life-style modifications. This review will provide an
overview of obesity and APS in pregnancy and will discuss endothelial dysfunction as mechanism for adverse obstetric outcome in these chronic diseases.