From the Guidelines
A pregnant woman in her mid-50s with Antiphospholipid Syndrome (APS) should follow a balanced diet providing approximately 2,200-2,400 calories daily with a macronutrient ratio of 20-25% protein, 45-55% carbohydrates, and 25-30% healthy fats. This diet should emphasize anti-inflammatory foods including omega-3 rich fish (salmon, mackerel) 2-3 times weekly, plenty of colorful vegetables and fruits, whole grains, lean proteins, and plant-based fats like olive oil, avocados, and nuts 1. She should consume 27mg of iron daily through iron-rich foods or supplements, 1,000mg calcium, 600mcg folate, and other prenatal vitamins as prescribed by her healthcare provider. Additionally, she should limit sodium to 2,300mg daily to help manage potential hypertension associated with APS and pregnancy. Due to her high-risk pregnancy (advanced maternal age and APS), she will likely be taking low-dose aspirin (81mg daily) and possibly heparin or low-molecular-weight heparin injections to prevent blood clots and pregnancy complications, as recommended by the 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases 1.
Types of APS
There are three main types of Antiphospholipid Syndrome (APS):
- Type I: includes patients with thrombosis and/or pregnancy morbidity, and the presence of lupus anticoagulant (LAC) and/or anticardiolipin antibodies (aCL) 1
- Type II: includes patients with thrombosis and/or pregnancy morbidity, and the presence of anti-β2-glycoprotein I antibodies (anti-β2GPI) 1
- Type III: includes patients with thrombosis and/or pregnancy morbidity, and the presence of multiple antiphospholipid antibodies (e.g., LAC, aCL, and anti-β2GPI) 1 It is possible for a patient to have all three types of APS, which is often referred to as "triple-positive" APS. This occurs when a patient has positive test results for LAC, aCL, and anti-β2GPI antibodies.
Management of APS in Pregnancy
The management of APS in pregnancy involves a combination of medical therapy and lifestyle modifications. The use of combined low-dose aspirin and prophylactic-dose heparin is strongly recommended for patients with obstetric APS 1. Additionally, hydroxychloroquine (HCQ) may be beneficial in reducing the risk of pregnancy complications in patients with primary APS 1. It is essential to work closely with a healthcare provider to develop a personalized management plan that takes into account the individual patient's needs and risk factors.
From the Research
Ideal Diet and Macronutrient Ratio for a Pregnant Woman with APS
- The ideal diet for a pregnant woman with Antiphospholipid Syndrome (APS) is not specifically outlined in the provided studies, but general dietary guidelines for pregnant women can be applied 2, 3, 4.
- A balanced diet that includes 3-4 portions of milk products, 2-3 portions of meat, fish or eggs, 3 portions of fruit, 4-5 portions of vegetables or greens, and 7-8 portions of cereals and legumes per day is recommended 2.
- Adherence to dietary recommendations for the prevention of cardiovascular disease, such as the Dietary Approaches to Stop Hypertension (DASH) diet, may also be beneficial in reducing the risk of hypertensive disorders of pregnancy 4.
Types/Groups of APS
- Antiphospholipid Syndrome (APS) represents a disease spectrum, with thrombosis and pregnancy morbidities being traditional hallmarks, as well as extra-criteria clinical phenotypes 5.
- There are three main types of antiphospholipid antibodies: lupus anticoagulant, anticardiolipin, and anti-β2-glycoprotein I 5.
- It is possible for a person to have all three types of antiphospholipid antibodies, which is often referred to as "triple positive" APS 6.
Management of APS during Pregnancy
- Careful monitoring and individualized obstetric care with the use of aspirin and heparin/low molecular weight heparin (LMWH) can improve pregnancy outcomes among pregnant individuals with APS 5.
- Timely interventions and proper prophylaxis are crucial in preventing catastrophic outcomes, such as irreversible vision loss, in pregnant women with APS complicated by pre-eclampsia 6.