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Am J Perinatol 2020; 37(09): 873-880
DOI: 10.1055/s-0039-3402752
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Samantha C. Do
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Nada M. Rizk
2   Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
,
Maurice L. Druzin
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Julia F. Simard 
2   Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
3   Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
› Author Affiliations
Further Information

Publication History

30 April 2019

02 December 2019

Publication Date:
03 January 2020 (online)

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Abstract

Objective Systemic lupus erythematosus (SLE) increases the risk of complications in pregnancy. Hydroxychloroquine (HCQ) decreases flares and neonatal lupus syndrome. Limited evidence suggests that HCQ also reduces preeclampsia and preterm birth in SLE pregnancies. We studied whether HCQ was associated with lower odds of preeclampsia and preterm delivery in SLE pregnancies.

Study Design We conducted a retrospective cohort study of 129 deliveries of 110 patients with SLE delivered at a single institution (2000–2017). HCQ exposure and preeclampsia, along with other clinical data, were extracted from chart review. Crude and multivariable-adjusted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs).

Results A total of 41% were exposed to HCQ, of whom 13.5% were complicated by preeclampsia versus 26.3% unexposed to HCQ (adjusted OR = 0.5; 95% CI: 0.2–1.4). The difference was pronounced for first pregnancies (7 vs. 44%), but power was limited. The difference in preterm deliveries was less pronounced comparing HCQ-exposed pregnancies with HCQ-unexposed pregnancies (34 vs. 40.8%; OR = 0.3; 95% CI: 0.3–1.5).

Conclusion Pregnant SLE patients trended toward less preeclampsia and preterm delivery when treated with HCQ. Future larger studies are needed to increase the statistical power, account for additional potential confounders, and more fully account for parity.

Keywords

lupus - pregnancy - preeclampsia - preterm - hydroxychloroquine
 

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