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Background:Empirical use of Hydroxychloroquine (HCQ) in patients with positive antinuclear antibody spectrum (ANAs) test result is controversial regarding its impact on improving perinatal outcomes. This study aimed to investigate the effect of HCQ on adverse pregnancy outcomes associated with placental dysfunction in ANAs-positive patients.Methods:The study included pregnant women with positive ANAs test result from 2016 to 2020 in our center, and divided into a weakly positive and a positive group in just ANA positive patients among them. Univariate and multivariate analyses were conducted to determine the effect of HCQ on pregnancy outcomes in each subgroup. Stratified and interactive analyses were performed to assess the value of HCQ in improving pregnancy outcomes.Results:(i) A total of 261 cases were included, accounting for 30.60% of pregnancy complicated with autoimmune abnormalities, and 65.12% of them used HCQ during pregnancy. (ii) The application of HCQ significantly reduced the incidence of early-onset preeclampsia (1.18% vs. 12.09%, p = 0.040) and small-for-gestational-age infants (10.06% vs. 25.84%, p = 0.003) in the ANAs-positive population, increased birth weight (3075.87 ± 603.91 g vs. 2847.53 ± 773.73 g, p = 0.025), and prolonged gestation (38.43 ± 2.31 vs. 36.34 ± 5.45 weeks, p < 0.001). (iii) A total of 185 just ANA-positive patients were stratified according to titers. Among them, the rate of HCQ usage was significantly higher than that in the weakly positive group (81.03% vs. 58.27%, p = 0.003). (vi) Stratified univariate analysis showed that HCQ usage in the ANA-positive group could reduce the incidence of preeclampsia (2.13% vs. 27.27%, p = 0.019) and prolong gestation (38.29 ± 2.54 vs. 34.48 ± 7.68 weeks, p = 0.006). In the ANA-weakly positive group, HCQ significantly reduced the incidence of preeclampsia (6.76% vs. 28.30%, p = 0.002), early-onset preeclampsia (1.35% vs. 13.21%, p = 0.027), and small-for-gestational-age infants (7.89% vs. 35.19%, p < 0.001). Multivariate regression analysis showed that HCQ significantly reduced the incidence of preeclampsia in both groups. Intergroup interaction analysis showed no significant difference in the value of HCQ in reducing the incidence of preeclampsia between the two groups.Conclusion:ANAs positivity is an important abnormal autoimmunity type in pregnancy. HCQ can be considered as a choice for improving adverse pregnancy outcomes related to placental dysfunction, such as preeclampsia, in this population.

Background: To investigate the risk factors for cervical insufficiency (CI) in women with polycystic ovarian syndrome (PCOS). Methods: A total of 1553 women with PCOS were selected as study group. Additionally, 1553 women without PCOS were randomly selected to comprise the control group. ①The level of androstenedione, insulin resistance (IR) and antimullerian hormone (AMH) before pregnancy were collected and analysed. ② According to whether they accepted embryo transfer and different transfer cycles, whether they accepted hysteroscopy before pregnancy and the time period before pregnancy, the impact of clinical intervention measures on the occurrence of CI in the above PCOS cases was analysed. Main results: ①The incidence of CI in PCOS cases was 6.2%(97/1553), which was significantly higher than the 1.2%(19/1553) in the non-PCOS group (P<0.05). PCOS was a risk factor for CI (OR=4.467, 95%CI: 2.616~7.628). ②The level of androstenedione before pregnancy in PCOS cases with CI was significantly higher than that in PCOS cases without CI (15.98±7.95nmol/L vs. 13.32±6.67nmol/L, P=0.01). There was no significant difference in IR and AMH levels between the two groups. ③Embryo transfer was a risk factor for the occurrence of CI in PCOS cases (OR=3.415, 95%CI: 2.092~5.574). In embryo transfer cases, the incidence of CI in fresh cycle embryo transfer cases was 9.4%(30/382), which was higher than the 7.9%(15/159) in frozen embryo transfer cases, without statistically significant. In frozen cycle embryo transfer cases, the incidence of CI in natural cycle cases was 8.0%(2/25), which was higher than the 6.3%(11/166) in artificial cycle cases, with no statistically significant. ④The incidence of CI in women who underwent hysteroscopy within six months before pregnancy was 17.2%(5/29), which was significantly higher than the 6.0%(92/1524) in women who underwent hysteroscopy beyond six months before pregnancy or who did not undergo hysteroscopy (P=0.031). Conclusion: ① PCOS women receiving embryo transfer and hyperandrogenemia should be included in the population at high risk of CI after pregnancy, and the monitoring of cervical length should be strengthened during pregnancy. ② Frozen cycle embryo transfer and artificial cycle embryo transfer in frozen cycle embryo transfer might reduce the incidence of CI.