Abstract
Objective To investigate the effect of hydroxychloroquine (HCQ) in pregnant women with systemic lupus erythematosus (SLE). Methods In SLE pregnancies of a single Dutch center (2000–2015), lupus activity and flares before and during pregnancy and postpartum were assessed using the SLE Disease Activity Index (SLEDAI)/SLEPDAI (SLEDAI adjusted for pregnancy). The association between HCQ use and pregnancy outcomes (early spontaneous abortion, fetal death, and preterm and term live birth) was analyzed using generalized estimating equations (GEE) accounting for the occurrence of multiple pregnancies per patient. Analyses were adjusted for antiphospholipid antibody (aPL) status. Results 110 pregnancies (63 mostly Caucasian patients) were included, of which, in 30, HCQ was used; overall occurrence of flares was low (non-HCQ group: 5 mild (6.4%) and 2 severe (2.6%); HCQ group: 2 mild (6.7%) and no severe flares). The HCQ group showed a trend towards lower dosage of prednisone (OR 0.2 (95% CI 0.0–1.4); p = 0.10). Pregnancy outcomes were comparable between groups. Among preterm live births, pregnancy duration was significantly longer in HCQ users (2.4 weeks (95% CI 1.0–3.8; p ≤ 0.001)). Conclusion HCQ use was associated with longer pregnancy duration in the vulnerable preterm birth population, underscoring the beneficial effect of HCQ use during pregnancy.
Highlights
Pregnancy constitutes a challenge in patients with systemic lupus erythematosus (SLE)
Pregnancy duration was significantly longer in HCQ users (2.4 weeks)
We investigated the association between HCQ use and disease activity as well as pregnancy outcomes in the SLE population followed at a single center
Summary
Pregnancy constitutes a challenge in patients with systemic lupus erythematosus (SLE). Apart from disease flares during pregnancy, SLE patients have an increased risk of intrauterine growth restriction (OR 2.6), (pre)eclampsia (OR 3.0), and preterm birth (OR 2.4) compared to the healthy population [1]. In SLE patients, the antimalarial drug hydroxychloroquine (HCQ) is used for the treatment of skin lesions and arthritis and for a more general goal, namely, prevention of cardiovascular disease and flares. A French retrospective study of 118 pregnancies in SLE patients who delivered after 22week gestation or longer found less preterm birth and intrauterine growth restriction in women who used HCQ during pregnancy compared to those who did not use HCQ in the six months prior to or during pregnancy [4]. Our study is the first to investigate multiple pregnancies in SLE women in a tertiary center in order to provide insight into the effects
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