Low-dose low-molecular-weight heparin prophylaxis against obstetrical complications in pregnancies with metabolic and immunological disorder-associated placental inflammation

Beksac, Mehmet Sinan; Özten, Gonca; Çakar, Ayşe Nur

doi:10.1080/14767058.2020.1760834

Cited by 22 publications

(18 citation statements)

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“…Anti‐inflammatory, antithrombotic and immunomodulatory prophylaxis are recommended for pregnancies having immune system problems, which may cause placental inflammation‐related obstetric complications 10 . This retrospective cohort consisted of pregnancies with poor obstetric history and immune system problems such as autoimmune disorders, autoimmune antibody positivities and chronic inflammatory/autoimmune diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Concomitantly, these immune system problems are associated with adverse obstetric complications and increased perinatal morbidity/mortality 1–9 . For this reason, women having such immune system problems should take the necessary precautions before getting pregnant and during their pregnancies to avoid experiencing relevant complications 3,10–12 …”

Section: Introductionmentioning

confidence: 99%

“…Anti‐inflammatory, antithrombotic and immune‐modulatory prophylaxis (low‐dose low molecular weight heparin, low‐dose salicylic acid and low‐dose corticosteroid) protocols were recommended during pregnancy in addition to the pre‐pregnancy case‐specific management protocols of immune system disorders, which are the risk factors for placental inflammation‐related obstetric complications 3,10,11 . HCQ is beneficial for women with SLE, SS, RA and antiphospholipid syndrome (APS), which are known to be morbid diseases in pregnancy 14–17 .…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9] For this reason, women having such immune system problems should take the necessary precautions before getting pregnant and during their pregnancies to avoid experiencing relevant complications. 3,[10][11][12] Hydroxychloroquine (HCQ), which was initially a drug for the treatment of malaria, is also indicated for the treatment of systemic lupus erythematosus (SLE), Sjogren syndrome (SS), and rheumatoid arthritis (RA). [13][14][15][16][17] HCQ should not be stopped if pregnancy is detected during therapy because the cessation of HCQ could precipitate a flare in maternal diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Adverse gestational and neonatal outcomes have not been associated with daily maternal doses of HCQ ≤400 mg. [18][19][20] Anti-inflammatory, antithrombotic and immunemodulatory prophylaxis (low-dose low molecular weight heparin, low-dose salicylic acid and low-dose corticosteroid) protocols were recommended during pregnancy in addition to the pre-pregnancy casespecific management protocols of immune system disorders, which are the risk factors for placental inflammation-related obstetric complications. 3,10,11 HCQ is beneficial for women with SLE, SS, RA and antiphospholipid syndrome (APS), which are known to be morbid diseases in pregnancy. [14][15][16][17] Teratological findings have not been reported with daily maternal doses of HCQ ≤400 mg. [18][19][20] HCQ can be detected in the cord blood at delivery in concentrations similar to those in the maternal serum.…”

Section: Introductionmentioning

confidence: 99%

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Impact of hydroxychloroquine on the gestational outcomes of pregnant women with immune system problems that necessitate the use of the drug

Beksac

Dönmez

2020

J of Obstet and Gynaecol

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Aim: To evaluate the impact of hydroxychloroquine (HCQ) on the perinatal outcomes of pregnancies with immune system disorders that necessitate the use of the drug. Methods: This cohort consisted of 202 pregnancies with poor obstetric history and immune system problems. Patients enrolled in special antenatal care program were administered low-dose low-molecular-weight heparin, low-dose salicylic acid and low-dose corticosteroid (prophylaxis protocol) as soon as their pregnancies were confirmed. Pregnancies with systemic lupus erythematosis, Sjogren syndrome and rheumatoid arthritis were additionally administered HCQ 200 mg daily as a part of their routine treatment. Pregnancies using HCQ were included in the study group (n = 39) while the remainders were included in control group (n = 163). We compared the groups in terms of the presence of miscarriage, fetal growth restriction (FGR), preeclampsia and preterm birth, as well as gestational week at birth, birthweight and "APGAR score of <7" at 10th minute. Results: Miscarriage rates were 28.2% and 28.2% while preterm birth rates were 16.6% and 28.2% in the control and study groups, respectively (P = 0.215). Preeclampsia and HCQ-related side effects were not detected in the groups. There were also no significant differences between the groups in terms of FGR, gestational day at birth, birthweight and the presence of "APGAR score <7" at 10th minute (P = 0.462, P = 0.064, P = 0.273 and P = 0.627, respectively). Conclusion: Low-dose low-molecular-weight heparin, low-dose salicylic acid and low-dose corticosteroid prophylaxis together with HCQ seem to be promising in pregnancies with immune system disorders. HCQ seems to be a safe and effective drug in low dosages.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%