Effect of Hydroxychloroquine on Lupus Activity, Preeclampsia and Intrauterine Growth Restriction in Pregnant Women with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome: A Systematic Review and Meta-Analysis

Hu, Zhengyan; Gao, Rui; Huang, Wanrong; Wang, Huiqing; Qin, Lang

doi:10.3390/jcm12020485

Cited by 9 publications

(4 citation statements)

References 42 publications

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“…A meta-analysis found an association between lower risk of preeclampsia and HCQ in SLE patients [ 160 , 161 ] but not in aPL/APS patients [ 161 ]. Contrary to that, Latino et al showed that high-risk APS patients treated with HCQ had a significantly lower rate of severe early onset preeclampsia compared to those treated without HCQ [ 162 ].…”

Section: Discussionmentioning

confidence: 99%

Preeclampsia and the Antiphospholipid Syndrome

Mayer-Pickel,

Nanda,

Gajic

et al. 2023

Biomedicines

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Antiphospholipid syndrome (APS) is characterized by venous or arterial thrombosis and/or adverse pregnancy outcome in the presence of persistent laboratory evidence of antiphospholipid antibodies (aPLs). Preeclampsia complicates about 10–17% of pregnancies with APS. However, only early onset preeclampsia (<34 weeks of gestation) belongs to the clinical criteria of APS. The similarities in the pathophysiology of early onset preeclampsia and APS emphasize an association of these two syndromes. Overall, both are the result of a defective trophoblast invasion and decidual transformation at early gestation. Women with APS are at increased risk for prematurity; the reasons are mostly iatrogenic due to placental dysfunction, such as preeclampsia or FGR. Interestingly, women with APS have also an increased risk for preterm delivery, even in the absence of FGR and preeclampsia, and therefore it is not indicated but spontaneous. The basic treatment of APS in pregnancy is low-dose aspirin and low-molecular-weight heparin. Nevertheless, up to 20–30% of women develop complications at early and late gestation, despite basic treatment. Several additional treatment options have been proposed, with hydroxychloroquine (HCQ) being one of the most efficient. Additionally, nutritional interventions, such as intake of vitamin D, have shown promising beneficial effects. Curcumin, due to its antioxidant and anti-inflammatory properties, might be considered as an additional intervention as well.

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Section: Discussionmentioning

confidence: 99%

Preeclampsia and the Antiphospholipid Syndrome

Mayer-Pickel,

Nanda,

Gajic

et al. 2023

Biomedicines

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“…HCQ is associated with higher gestational age at delivery, suggesting its positive effect on the prolongation of pregnancy ( Sciascia et al, 2016 ; Kroese et al, 2017 ; Gerde et al, 2021 ) and an increase in live births in patients with APS ( Mekinian et al, 2015 ; Sciascia et al, 2016 ; Gerde et al, 2021 ). Some retrospective studies and meta-analyses associated HCQ with a lower risk of PE in SLE ( Do et al, 2020 ; Hu et al, 2023 ; Phillips et al, 2023 ) and in APS patients ( Sciascia et al, 2016 ; Latino et al, 2020 ) who continued to take it during pregnancy.…”

Section: Hydroxychloroquine (Hcq)mentioning

confidence: 99%

Deciphering the immunological interactions: targeting preeclampsia with Hydroxychloroquine’s biological mechanisms

Gajić,

Schröder-Heurich,

Mayer-Pickel

2024

Front. Pharmacol.

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Preeclampsia (PE) is a complex pregnancy-related disorder characterized by hypertension, followed by organ dysfunction and uteroplacental abnormalities. It remains a major cause of maternal and neonatal morbidity and mortality worldwide. Although the pathophysiology of PE has not been fully elucidated, a two-stage model has been proposed. In this model, a poorly perfused placenta releases various factors into the maternal circulation during the first stage, including pro-inflammatory cytokines, anti-angiogenic factors, and damage-associated molecular patterns into the maternal circulation. In the second stage, these factors lead to a systemic vascular dysfunction with consecutive clinical maternal and/or fetal manifestations. Despite advances in feto-maternal management, effective prophylactic and therapeutic options for PE are still lacking. Since termination of pregnancy is the only curative therapy, regardless of gestational age, new treatment/prophylactic options are urgently needed. Hydroxychloroquine (HCQ) is mainly used to treat malaria as well as certain autoimmune conditions such as systemic lupus and rheumatoid arthritis. The exact mechanism of action of HCQ is not fully understood, but several mechanisms of action have been proposed based on its pharmacological properties. Interestingly, many of them might counteract the proposed processes involved in the development of PE. Therefore, based on a literature review, we aimed to investigate the interrelated biological processes of HCQ and PE and to identify potential molecular targets in these processes.

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“…133 Randomized controlled trials are needed to test the hypothesis that female reproductive health depends on well-being together with a balanced diet and physical activity, homocysteine and hormonal homeostasis, infection and inflammation control, 73 and suppression of autoantibodies. 134 Interventions to improve mental health must take into consideration the fact that infertility-related distress does not necessarily subside during pregnancy. 1…”

Section: Strategies To Treat Infertility and Reduce The Risk Of Place...mentioning

confidence: 99%

The Impact of Emotional Responses on Female Reproduction: Fibrinolysis in the Spotlight

Hoirisch-Clapauch

2024

Semin Thromb Hemost

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Fibrinolytic enzymes modify various substrates required for tissue remodeling, playing a crucial role in mechanisms underlying resilience, reward processing, ovulation, embryo implantation, and placentation. Individuals with low resilience and reduced reward responsiveness, when exposed to chronic stress, are at increased risk of experiencing a range of negative emotions. Chronic anxiety and melancholia are examples of negative emotions associated with hypercortisolism, while fear and atypical depression are characterized by systemic inflammation. Both cortisol and inflammatory cytokines stimulate the production of plasminogen activator inhibitor-1 (PAI-1), a potent fibrinolysis inhibitor. Chronic anxiety, fear, and depression are among the many hypofibrinolytic conditions increasing the risk of oligo-anovulation, miscarriage, fetal growth restriction, and preeclampsia. Although significant, the impact of negative emotions on implantation is not as obvious as on ovulation or placentation. Other hypofibrinolytic conditions that may affect female reproduction through mechanisms dependent or independent of PAI-1 include metabolic disturbances (e.g., due to consumption of highly palatable foods, often used to alleviate negative affect), inflammation, hyperhomocysteinemia, hypothyroidism, hypercortisolism, antiphospholipid antibodies, and the 4G allele of the PAI-1 gene. Benzodiazepines and antidepressants should be used with caution in the first trimester as this combination may cause malformations. Also, selective serotonin reuptake inhibitors have fibrinolytic properties that increase the risk of bleeding after surgical procedures. Psychological interventions, especially group therapy, are effective in the prevention of reproductive disorders. Controlled trials are needed to test the hypothesis that female reproductive health depends on psychological well-being, a balanced diet and physical activity, suppression of inflammation and autoantibodies, and homocysteine and hormonal homeostasis.

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Effect of Hydroxychloroquine on Lupus Activity, Preeclampsia and Intrauterine Growth Restriction in Pregnant Women with Systemic Lupus Erythematosus and/or Antiphospholipid Syndrome: A Systematic Review and Meta-Analysis

Cited by 9 publications

References 42 publications

Preeclampsia and the Antiphospholipid Syndrome

Preeclampsia and the Antiphospholipid Syndrome

Deciphering the immunological interactions: targeting preeclampsia with Hydroxychloroquine’s biological mechanisms

The Impact of Emotional Responses on Female Reproduction: Fibrinolysis in the Spotlight

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