Obesity and Antiphospholipid Syndrome: A Particular Challenge in Pregnancy

Abstract

Obesity is associated with a broad spectrum of chronic diseases, as well as cardiovas- cular 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 diabe- tes, 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 (an- ticardiolipin antibodies/ACLA, lupus antikoagulans/LA and s2-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 mecha- nism for adverse obstetric outcome in these chronic diseases.