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. 2024 Jun;76(6):919-927.
doi: 10.1002/art.42793. Epub 2024 Feb 19.

Hydroxychloroquine in Lupus Pregnancy and Risk of Preeclampsia

Amadeia Rector  1 , Ivana Marić  1 , Yashaar Chaichian  1 , Eliza Chakravarty  2 , Miranda Cantu  3 , Michael H Weisman  1 , Gary M Shaw  1 , Maurice L Druzin  1 , Julia F Simard  1
Affiliations

Hydroxychloroquine in Lupus Pregnancy and Risk of Preeclampsia

Amadeia Rector et al. Arthritis Rheumatol. 2024 Jun.

Abstract

Objective: Systemic lupus erythematosus (SLE) disproportionately affects women during childbearing years, and hydroxychloroquine (HCQ) is the standard first-line treatment. Preeclampsia complicates up to one-third of pregnancies in lupus patients, although reports vary by parity and multifetal gestation. We investigated whether taking HCQ early in pregnancy may reduce the risk of preeclampsia.

Methods: We studied 1,068 live birth singleton pregnancies among 1,020 privately insured patients with SLE (2007-2016). HCQ treatment was defined as three months preconception through the first trimester, and prescription fills were a proxy for taking HCQ. Modified Poisson regression estimated risk ratios (RRs) and 95% confidence intervals (CIs), stratified by parity. Propensity scores accounted for confounders, and stratified analyses examined effect modification.

Results: Approximately 15% of pregnant patients were diagnosed with preeclampsia. In 52% of pregnancies, patients had one or more HCQ fills. Pregnant patients exposed to HCQ had more comorbidities, SLE activity, and azathioprine treatment. We found no evidence of a statistical association between HCQ and preeclampsia among nulliparous (RR 1.26 [95% CI 0.82-1.93]) and multiparous pregnancies (RR 1.20 [95% CI 0.80-1.70]). Additional controls for confounding decreased the RRs toward the null (nulliparous pregnancy, propensity score-adjusted [PS-adj] RR 1.09 [95% CI 0.68-1.76]; multiparous pregnancy, PS-adj RR 1.01 [95% CI 0.66-1.53]).

Conclusion: Using a large insurance-based database, we did not observe a decreased risk of preeclampsia associated with HCQ treatment in pregnancy, although we cannot rule out residual and unmeasured confounding and misclassification. Further studies leveraging large population-based data and prospective collection could characterize how HCQ influences preeclampsia risk in pregnant patients with SLE and among persons at greater risk of hypertensive disorders of pregnancy.

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Figures

Figure 1
Figure 1
Flowchart of SLE pregnancy cohort, 2007–2016. SLE= systemic lupus erythematosus, LB=livebirth, SB=stillbirth, MB=mixed birth
Figure 2
Figure 2
HCQ exposure in early pregnancy among patients with SLE from 2007–2016. HCQ exposure was defined as one or more fills (A.) or two or more fills (B.) occurring from 3 months before pregnancy to the end of the first trimester. SLE= systemic lupus erythematosus; HCQ= hydroxychloroquine
See this image and copyright information in PMC

References

    1. Andreoli L, Fredi M, Nalli C, et al. Pregnancy implications for systemic lupus erythematosus and the antiphospholipid syndrome. J Autoimmun. 2011;38(2–3):J197–208. doi:10.1016/j.jaut.2011.11.010 - DOI - PubMed
    1. Peart E, Clowse MEB. Systemic lupus erythematosus and pregnancy outcomes: an update and review of the literature. Curr Opin Rheumatol. 2014;26(2):118–123. doi:10.1097/BOR.0000000000000030 - DOI - PubMed
    1. Clowse MEB, Jamison M, Myers E, James AH. A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol. 2008;199(2):127.e1–6. doi:10.1016/j.ajog.2008.03.012 - DOI - PMC - PubMed
    1. Palmsten K, Hernández-Díaz S, Kuriya B, Solomon DH, Setoguchi S. Use of disease-modifying antirheumatic drugs during pregnancy and risk of preeclampsia. Arthritis Care Res (Hoboken). 2012;64(11):1730–1738. doi:10.1002/acr.21807 - DOI - PMC - PubMed
    1. Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020;72(4):529–556. doi:10.1002/art.41191 - DOI - PubMed

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