Pregnancy-associated exposure reduction to medications used for antiphospholipid syndrome: a systematic review
Bibliographic record
Abstract
Objectives: Pregnancy-associated hypercoagulability and potential changes in drug disposition increase the risk of anticoagulant treatment failure for pregnant women with antiphospholipid syndrome (APS), which is characterised by thrombotic and obstetric complications. We conducted a systematic review of pregnancy-associated pharmacokinetic (PK) changes of medications commonly used for APS. Methods: We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Pharmaceutical Abstracts. Publications of PK assessment in pregnant individuals compared to nonpregnant controls were included. Six target drugs in 3 groups were low-dose aspirin, heparins (unfractionated heparin and low molecular weight heparin), and antimalarial (hydroxychloroquine and chloroquine). PK parameters in pregnancy including apparent clearance (CL) were compared to those of the nonpregnant state. Results: In 3460 screened publications, we identified 12 articles. Of the 3 drug groups, only heparins included studies of pregnant women with APS. Despite the diverse PK profiles of these drugs, all 6 drugs showed statistically significant changes of 1.5- to 2-fold represented by decreased area under the curve, lower peak concentration, and/or increased CL with large interindividual variations. Details of postpartum recovery profiles of the PK changes were not reported in any of the studies. Conclusions: Limited evidence shows the reduction of exposure to APS medications during pregnancy, implying a higher risk of therapeutic failure. Although the clinical impact of the PK changes awaits sufficiently powered studies, the lack of PK data in pregnancy and postpartum remains a significant challenge in women's health.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.007 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".