Health-Related Quality of Life during Pregnancy of Filipino Patients with Antiphospholipid Syndrome in Philippine General Hospital

A Qualitative Study

Authors

  • Raisa Cagurangan Millan, MD University of the Philippines - Philippine General Hospital
  • Mary Anne R. Castor, MD University of the Philippines - Philippine General Hospital https://orcid.org/0000-0003-2291-4615
  • Carol Stephanie C. Tan-Lim, MD University of the Philippines - Philippine General Hospital https://orcid.org/0000-0001-8815-4191
  • Jenifer R. Otadoy-Agustin, MD University of the Philippines - Philippine General Hospital https://orcid.org/0009-0009-9627-9563
  • Roxanne J. Casis Hao, MD University of the Philippines - Philippine General Hospital https://orcid.org/0000-0003-4094-7736
  • Maria Bettina P. Quiambao, MD University of the Philippines - Philippine General Hospital https://orcid.org/0000-0003-1357-0136
  • Ma. Socorro L. Agcaoili-De Jesus, MD University of the Philippines - Philippine General Hospital
  • Cherie C. Ocampo-Cervantes, MD University of the Philippines - Philippine General Hospital
  • Lara Theresa Alentajan-Aleta, MD University of the Philippines - Philippine General Hospital

DOI:

https://doi.org/10.70552/pjaai.26.1.17473

Keywords:

Health-related quality of life, antiphospholipid syndrome (APS), pregnant

Abstract

Objective: This study aims to provide qualitative data on the health-related quality of life (HRQoL) during pregnancy of Filipino patients with antiphospholipid syndrome (APS).

Methodology: This study utilized focus group discussions (FGDs) to gather experiences, perceptions, and behaviors of patients with APS during their pregnancy. Participants included pregnant patients or patients who delivered in the past 6 months, diagnosed with APS, whether classified as Secondary APS, Primary APS, or Non-criteria APS. This is a qualitative study that underwent five stages in data analysis: 1) data collection, 2) familiarizing and identifying thematic framework, 3) indexing, ranking, and listing of statements per theme, 4) rearranging context under appropriate thematic content, and 5) mapping and interpretation.

Results: A total of 5 FGDs were conducted, with 15 participants in all. The majority (93%) had poor overall quality of life. The most common factor was the medication's financial implications. Most had limitations in daily activities (87%) and sleep disturbance (67%). All participants expressed satisfaction with access to healthcare and with the services they received at the hospital. Support from the partner and family, and following the doctor's advice, were the most common coping mechanisms for the disease and its management.

Conclusion: The majority of patients demonstrated understanding of the basic knowledge of APS. Despite satisfaction with access to health services and information from physicians, there was dissatisfaction with overall quality of life, mainly due to the financial burden of medication, which also caused physical and psychological dissatisfaction. In contrast, financial support from family fostered social satisfaction.

Author Biographies

Raisa Cagurangan Millan, MD, University of the Philippines - Philippine General Hospital

Division of Allergy and Immunology, Department of Medicine, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines

Mary Anne R. Castor, MD, University of the Philippines - Philippine General Hospital

Division of Allergy and Immunology, Department of Pediatrics, University of the Philippines - Philippine General Hospital

Carol Stephanie C. Tan-Lim, MD, University of the Philippines - Philippine General Hospital

Division of Allergy and Immunology, Department of Pediatrics, University of the Philippines - Philippine General Hospital

Jenifer R. Otadoy-Agustin, MD, University of the Philippines - Philippine General Hospital

Division of Allergy and Immunology, Department of Medicine, University of the Philippines - Philippine General Hospital

Roxanne J. Casis Hao, MD, University of the Philippines - Philippine General Hospital

Division of Allergy and Immunology, Department of Pediatrics, University of the Philippines - Philippine General Hospital

Maria Bettina P. Quiambao, MD, University of the Philippines - Philippine General Hospital

Division of Allergy and Immunology, Department of Medicine, University of the Philippines - Philippine General Hospital

Ma. Socorro L. Agcaoili-De Jesus, MD, University of the Philippines - Philippine General Hospital

Division of Allergy and Immunology, Department of Medicine, University of the Philippines - Philippine General Hospital

Cherie C. Ocampo-Cervantes, MD, University of the Philippines - Philippine General Hospital

Division of Allergy and Immunology, Department of Medicine, University of the Philippines - Philippine General Hospital

Lara Theresa Alentajan-Aleta, MD, University of the Philippines - Philippine General Hospital

Division of Allergy and Immunology, Department of Medicine, University of the Philippines - Philippine General Hospital

References

1. Philippine Statistics Authority. Philippines 2022 demographic and health survey summary report. Philippine Statistics Authority; 2023. https://dhsprogram.com/pubs/pdf/SR276/SR276.pdf

2. Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. 2021;397(10285):1658-67. https://pubmed.ncbi.nlm.nih.gov/33915094 https://doi.org/10.1016/S0140-6736(21)00682-6

3. Alijotas-Reig J, Esteve-Valverde E, Anunciacion-Llunell A, Marques-Soares A, Pardos-Gea J. Pathogenesis, diagnosis and management of obstetric antiphospholipid syndrome: a comprehensive review. J Clin Med. 2022;11(3):675. https://pubmed.ncbi.nlm.nih.gov/35160128 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836886 https://doi.org/10.3390/jcm11030675

4. D'Ippolito S, Barbaro G, Paciullo C, Tersigni C, Scambia G, Di Simone N. Antiphospholipid syndrome in pregnancy: new and old pathogenetic mechanisms. Int J Mol Sci. 2023;24(4):3195. https://pubmed.ncbi.nlm.nih.gov/36834614 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9966557 https://doi.org/10.3390/ijms24043195

5. Santacruz JC, Mantilla MJ, Rueda I, Pulido S, Rodriguez G, Londono J. Obstetric antiphospholipid syndrome from the perspective of a rheumatologist. Cureus. 2022;14(1):e21090. https://pubmed.ncbi.nlm.nih.gov/35165550 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8830433 https://doi.org/10.7759/cureus.21090

6. Gotay CC, Korn EL, McCabe MS, Moore TD, Cheson DD. Quality-of-life assessment in cancer treatment protocols: research issues in protocol development. J Natl Cancer Inst. 1992;84(8):575-9. https://pubmed.ncbi.nlm.nih.gov/1556768 https://doi.org/10.1093/jnci/84.8.575

7. DeLateur BJ. Quality of life: a patient-centered outcome. Arch Phys Med Rehabil. 1997;78(3):237-9. https://pubmed.ncbi.nlm.nih.gov/9084342 https://doi.org/10.1016/s0003-9993(97)90026-5

8. Choi YJ. A Study on factors that affect quality of life of the elderly by age. Hanyoung Theological University. Seoul City, Korea; 2008.

9. Lee E, Cha S, Kim GM. Factors affecting health-related quality of life in multimorbidity. Healthcare (Basel). 2021;9(3):334. https://pubmed.ncbi.nlm.nih.gov/33809631 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001381 https://doi.org/10.3390/healthcare9030334

10. Siboni FS, Alimoradi Z, Atashi V, Alipour M, Khatooni M. Quality of life in different chronic diseases and its related factors. Int J Prev Med. 2019;10:65. https://pubmed.ncbi.nlm.nih.gov/31198500 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547796 https://doi.org/10.4103/ijpvm.IJPVM_429_17

11. McHorney CA, Ware JE Jr, Lu JFR, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32(1):40-66. https://pubmed.ncbi.nlm.nih.gov/8277801 https://doi.org/10.1097/00005650-199401000-00004

12. Wong LP. Focus group discussion: a tool for health and medical research. Singapore Med J. 2008;49(3):256-60. https://pubmed.ncbi.nlm.nih.gov/18363011

13. Kitzinger J. Qualitative research: introducing focus groups. BMJ. 1995;311(7000):299-302. https://pubmed.ncbi.nlm.nih.gov/7633241 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2550365 https://doi.org/10.1136/bmj.311.7000.299

14. Basnet HB. Focus group discussion: a tool for qualitative inquiry. Researcher. 2018;3(3):81. Dhttps://doi.org/10.3126/researcher.v3i3.21553

15. Kitzinger J. The methodology of focus groups: the importance of interaction between research participants. Sociol Health Illn. 1994;16:103-21. https://doi.org/10.1111/1467-9566.ep11347023

16. Leung K, Wu E, Lue B, Tang L. The use of focus groups in evaluating quality of life components among elderly Chinese people. Qual Life Res. 2004;13(1):179-90. https://pubmed.ncbi.nlm.nih.gov/15058799 https://doi.org/10.1023/B:QURE.0000015291.79826.a8

17. Rolan EP, Robertson O, Nonkovic N, Marceau K. Reliability of prospective and retrospective maternal reports of prenatal experiences. BMC Pregnancy Childbirth. 2022;22(1):968. https://pubmed.ncbi.nlm.nih.gov/36575374 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793511 https://doi.org/10.1186/s12884-022-05286-7

18. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL group. Psychol Med. 1998;28(3):551-8. https://pubmed.ncbi.nlm.nih.gov/9626712 https://doi.org/10.1017/s0033291798006667

19. Morse WC, Lowery DR, Steury T. Exploring saturation of themes and spatial locations in qualitative public participation geographic information systems research. Soc Nat Resour. 2014;27(5):557-71.

20. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field methods. 2006;18(1):59-82. https://doi.org/10.1177/1525822X05279903

21. Krueger RA, Casey MA. Focus groups: a practical guide for applied research, 4th ed. Sage Publications; 2000.

22. Rabiee F. Focus-group interview and data analysis. Proc Nutr Soc. 2004;63(4):655-60. https://pubmed.ncbi.nlm.nih.gov/15831139 https://doi.org/10.1079/pns2004399

23. van Eeuwijk P, Angehrn Z. How to conduct a focus group discussion: methodological manual. Swiss Tropical and Public Health Institute; 2017. https://www.swisstph.ch/fileadmin/user_upload/SwissTPH/Topics/Society_and_Health/Focus_Group_Discussion_Manual_van_Eeuwijk_Angehrn_Swiss_TPH_2017.pdf

24. University of Mississippi. Guidelines for conducting a focus group. Eliot and associates; 2005. https://irep.olemiss.edu/wp-content/uploads/sites/98/2016/05/Trinity_Duke_How_to_Conduct_a_Focus_Group.pdf

25. Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, eds. Analysing qualitative data. Routledge; 1994.

26. Boutib A, Chergaoui S, Marfak A, Hilali A, Youlyouz-Marfak I. Quality of life during pregnancy from 2011 to 2021: systematic review. Int J Womens Health. 2022;14:975-1005. https://pubmed.ncbi.nlm.nih.gov/35941917 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356752 https://doi.org/10.2147/IJWH.S361643

27. Lagadec N, Steinecker M, Kapassi A, et al. Factors influencing the quality of life of pregnant women: a systematic review. BMC Pregnancy Childbirth. 2018;18(1):455. https://pubmed.ncbi.nlm.nih.gov/30470200 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251086 https://doi.org/10.1186/s12884-018-2087-4

28. Amana IG, Tefera E, Chaka E, Bulto G. Health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia Region, Ethiopia: a community-based cross-sectional study. BMC Womens Health. 2024;24(1):79. https://pubmed.ncbi.nlm.nih.gov/38297361 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10829299 https://doi.org/10.1186/s12905-024-02918-2

29. Lee EE, Jun JK, Lee EB. Management of women with antiphospholipid antibodies or antiphospholipid syndrome during pregnancy. J Korean Med Sci. 2021;36(4):e24. https://pubmed.ncbi.nlm.nih.gov/33496084 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834901 https://doi.org/10.3346/jkms.2021.36.e24

30. Republic of the Philippines Department of Health. An act expanding the benefits and privileges of persons with disability. 2017. https://ncda.gov.ph/disability-laws/administrative-orders/doh-ao-2017-0008-implementing-guidelines-of-republic-act-10754

31. Branch DW, Khamashta MA. Antiphospholipid syndrome: obstetric diagnosis, management, and controversies. Obstet Gynecol. 2003;101(6):1333-44. https://pubmed.ncbi.nlm.nih.gov/12798544 https://doi.org/10.1016/s0029-7844(03)00363-6

32. PhilHealth. PhilHealth raises awareness on benefits for women. 2022. . https://www.philhealth.gov.ph/news/2022/women_benefits.pdf

33. World Health Organization. Physical activity. Published June 26, 2024. https://www.who.int/news-room/fact-sheets/detail/physical-activity

34. Biddle SJH, Ciaccioni S, Thomas G, Vergeer I. Physical activity and mental health in children and adolescents: an updated review of reviews and an analysis of causality. Psychol Sport Exerc. 2019;42:146-55. https://doi.org/10.1016/j.psychsport.2018.08.011

35. Demissie Z, Siega-Riz AM, Evenson KR, Herring AH, Dole N, Gaynes BN. Physical activity and depressive symptoms among pregnant women: the PIN3 study. Arch Womens Ment Health. 2001;14(2):145-57. https://pubmed.ncbi.nlm.nih.gov/21107623 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399732 https://doi.org/10.1007/s00737-010-0193-z

36. Gris JC, Guillotin F, Chea M, Fortier M, Bourguignon C, Mercier E, Bouvier S. Antiphospholipid syndrome in pregnancy: neuropsychiatric aspects. Thromb Update. 2021;5:100078. https://doi.org/10.1016/j.tru.2021.100078

37. Sampogna G, Luciano M, Di Vincenzo M, et al. Physical activity influences adherence to pharmacological treatments in patients with severe mental disorders: results from the multicentric, randomized controlled LIFESTYLE trial. Front Pharmacol. 2023;14:1285383. https://pubmed.ncbi.nlm.nih.gov/38152689 https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC10752611 https://doi.org/10.3389/fphar.2023.1285383

38. Setyawati A, Herliani YK, Harun H, Maulana S, Amirah S. The quality of life among women with pre-eclampsia: a pilot descriptive study. Open Access Maced J Med Sci. 2022;10(G):739-43. DOI: 10.3889/oamjms.2022.10643

39. Stansfeld S. Social support and social cohesion. In: Marmot M, Wilkinson RG, eds. Social determinants of health. Oxford University Press; 1998.

40. Berkman L, Glass T. Social integration, social networks, social support, and health. In: Berkman L, Kawachi I, eds. Social Epidemiology. Oxford University Press; 2000.

41. Umberson D, Crosnoe R, Reczek C. Social relationships and health behaviors across the life course. Annu Rev Sociol. 2010;36:139-57. https://pubmed.ncbi.nlm.nih.gov/21921974 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171805 https://doi.org/10.1146/annurev-soc-070308-120011

42. Zachariah R. Social support, life stress, and anxiety as predictors of pregnancy complications in low-income women. Res Nurs Health. 2009;32(4):391-404. https://pubmed.ncbi.nlm.nih.gov/19434649 https://doi.org/10.1002/nur.20335

43. Bello CB, Esan D, Akerele S, Fadare R. Maternal health literacy, utilisation of maternal healthcare services and pregnancy outcomes among newly delivered mothers: a cross-sectional study in Nigeria. Public Health Pract (Oxf). 2022;3:100266. https://pubmed.ncbi.nlm.nih.gov/36101756 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9461586 https://doi.org/10.1016/j.puhip.2022.100266

44. Desnoyers M, Duforst V, Wahl D, Zuily S. Health-related quality of life in antiphospholipid syndrome: current knowledge and future perspectives. Curr Rheumatol Rep. 2020;22(6):20. https://pubmed.ncbi.nlm.nih.gov/32405870 https://doi.org/10.1007/s11926-020-00900-z

Downloads

Published

07/14/2026

How to Cite

Millan, R. C., Castor, M. A., Tan-Lim, C. S., Otadoy-Agustin, J., Casis Hao, R., Quiambao, M. B., … Alentajan-Aleta, L. T. (2026). Health-Related Quality of Life during Pregnancy of Filipino Patients with Antiphospholipid Syndrome in Philippine General Hospital: A Qualitative Study. Philippine Journal of Allergy, Asthma and Immunology, 26(1), 1–14. https://doi.org/10.70552/pjaai.26.1.17473