Can Antiphospholipid Syndrome Cause Recurrent Abortions in the First Month of Gestation?
Yes, Antiphospholipid Syndrome (APS) definitively causes recurrent spontaneous abortions in the first month of gestation, and this is a core diagnostic criterion for the condition. 1
Diagnostic Criteria and Early Pregnancy Loss
APS is characterized by persistent antiphospholipid antibodies (tested 12 weeks apart) combined with clinical manifestations including three or more consecutive spontaneous abortions before the 10th week of gestation (which encompasses the first month). 1
The American Heart Association/American Stroke Association 2021 guidelines explicitly state that APS diagnostic criteria include "pregnancy morbidity," with testing recommended for women with "second trimester abortion" history, though the full criteria encompass early losses as well. 1
The American College of Chest Physicians guidelines (2012) strongly recommend screening for antiphospholipid antibodies in women with recurrent early pregnancy loss (three or more miscarriages before 10 weeks of gestation) (Grade 1B recommendation). 1
Clinical Evidence and Epidemiology
The association between APS and first-trimester losses is well-established:
Among renal transplant candidates, approximately 40% of SLE patients have antiphospholipid antibodies, and these antibodies are specifically "associated with thrombocytopenia, in vitro coagulation abnormalities, thrombotic events, and fetal abortion." 1
In a large observational study (NOH-APS), women with purely obstetric APS were specifically defined as those who had experienced 3 consecutive spontaneous abortions before the 10th week of gestation or 1 fetal loss at or beyond the 10th week, confirming that early first-trimester losses are a hallmark of the condition. 2
Recent epidemiological data indicates that approximately 54% of recurrent miscarriages are associated with OAPS or antiphospholipid antibodies. 3
Pathophysiology Beyond Thrombosis
While thrombosis at the maternal-fetal interface was historically considered the primary mechanism, recent evidence reveals a more complex picture:
Contemporary research demonstrates that thrombosis in the maternal-fetal interface is actually uncommon, but various inflammatory factors are significantly increased in OAPS patients. 3
Multiple pathogenic mechanisms are now recognized, including inflammation and complement activation, which contribute to early pregnancy complications beyond simple clot formation. 4
Treatment Implications
For women with confirmed APS and recurrent early pregnancy loss:
Standard treatment consists of low-molecular-weight heparin (LMWH) plus low-dose aspirin starting as soon as pregnancy is diagnosed. 2, 5
Historical data shows dramatic improvement: in one study, all 14 patients treated early (as soon as pregnancy was diagnosed) with acetylsalicylic acid and/or fluocortolone had successful pregnancies, while 5 of 6 untreated patients experienced spontaneous abortion. 5
More recent data confirms that anti-inflammatory plus anticoagulation regimens show superior outcomes compared to simple anticoagulation, with repeat abortion rates of 11.11% versus 22.70%. 6
Clinical Caveat
A critical pitfall: Many patients with positive antiphospholipid antibodies and pathological pregnancy histories do not meet the strict classification criteria for APS, leading to widespread issues of incorrect diagnosis and delayed treatment. 3 The classification criteria were established for research purposes, not clinical management, so clinicians must use clinical judgment when aPLs are present with recurrent early losses even if formal criteria aren't fully met. 3