Hydroxychloroquine treatment during pregnancy in lupus patients is associated with lower risk of preeclampsia

Abstract

Background Hydroxychloroquine (HCQ) is regarded as a mainstay in the treatment of systemic lupus erythematosus (SLE) because of its efficacy in preventing flares, achieving remission, and reducing overall mortality. However, the impact of HCQ on pregnancy outcomes remains controversial. Objective We aimed to investigate the effect of HCQ on pregnancy outcomes in patients with SLE. Methods We performed a retrospective cohort study of 151 pregnancies in 122 patients with SLE (80 pregnancies in the HCQ treatment group and 71 pregnancies in the HCQ nontreatment group). We reviewed baseline characteristics including maternal comorbidities such as antiphospholipid syndrome, lupus nephritis, and autoimmune hepatitis. Pregnancy outcomes (preeclampsia, preterm delivery, and fetal growth restriction) and neonatal outcomes (gestational age at delivery and birth weight) were compared between HCQ treatment and nontreatment groups. Results Preeclampsia was significantly less complicated (7.5% vs 19.7%, p = 0.032) and neonatal birth weight was significantly greater (2757.0 ± 583.5 g vs 2542.3 ± 908.3 g, p = 0.001) in the HCQ treatment group than in the HCQ nontreatment group. Multiple logistic analysis adjusting for body mass index (BMI), lupus nephritis, serum uric acid, and estimated glomerular filtration rate revealed HCQ treatment was associated with exceedingly lower risk of preeclampsia in SLE pregnancy (odds ratio (OR) 0.106 (confidence interval (CI) 0.017–0.671)). Other independent risk factors for preeclampsia were a high prepregnancy BMI (OR 1.575 (CI 1.114–2.227)) and low eGFR level (OR 0.931 (CI 0.886–0.979)) before pregnancy. Conclusion Our data showed pregnancy outcomes in SLE patients can be improved in the HCQ treatment group with about 90% reduction of preeclampsia.

Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study

“…Our results support recent information about antimalarial drugs reducing the risk of developing preeclampsia in women with SLE. 29 On the other hand, active disease before and during pregnancy is associated with an increased risk of developing preeclampsia, as it has been previously reported. 32,[34][35][36][37][38][39] In fact some of these angiogenic factors are potential biomarkers for predicting preeclampsia in patients with SLE and APS, such as endoglin, sFlt-1 and PIGF, because these factors are progressively elevated in patients who are complicated with preeclampsia.…”

“…For the analysis, each pregnancy was con- The sample size calculation was performed based on the results of a recently published study that found that 7.5% of patients exposed to hydroxychloroquine developed preeclampsia compared to 19.7% in those unexposed patients. 29 With these data, using an alpha error of 0.05 and a beta error of 0.2, a minimum of 196 pregnancies were obtained to have a statistical power of 80%. The multivariate analysis with binary logistic regression was performed to identify potential independent risk factors for preeclampsia.…”

Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage

“…The pregnancy duration was longer for HCQ‐treated women (27.6 vs. 21.5 weeks; P = 0.03), and the new‐born birth weight was higher (3 kg vs. 2.3 kg; P = 0.04). Similarly, a retrospective Chinese study of 152 pregnancies in 122 women with SLE reported an 89% reduction in PE in HCQ‐treated women vs. non‐HCQ‐treated women …”

Does Hydroxychloroquine Protect against Preeclampsia and Preterm Delivery in Systemic Lupus Erythematosus Pregnancies?

“…Our finding that HCQ decreases the risk of preeclampsia is consistent with a recently published retrospective cohort study of 151 SLE pregnancies managed at a single institution from 1995 to 2018. 11 Seo et al showed that preeclampsia was significantly less common in the HCQ treatment group (19.7 vs. 7.5%; p ¼ 0.032). Our study provides further evidence supporting the protective effect of HCQ against preeclampsia.…”

“…[8][9][10] Emerging evidence suggests that HCQ may reduce the risk of preeclampsia. 11 Preeclampsia affects up to 30% of SLE pregnancies compared with 3.4% of pregnancies in the United States overall. [12][13][14][15][16] Preeclampsia increases maternal risks of stroke, renal failure, hepatic failure, and death.…”