Abstract
Background: Systemic lupus erythematosus (SLE) is an autoimmune disease commonly encountered during pregnancy. The use of hydroxychloroquine (HCQ) for SLE treatment in pregnancy has been supported by a few small studies performed in populations dissimilar from populations in the United States. Our objective was to compare maternal and neonatal outcomes in pregnant patients with SLE treated with and without HCQ at a tertiary care center in the United States.Methods: We conducted a retrospective cohort study of patients with SLE and singleton gestations who delivered at the University of Alabama at Birmingham from 2006 to 2013. Patients treated with HCQ during pregnancy were compared with patients who did not receive HCQ. Key outcomes included maternal morbidities (hypertensive disorders, intrauterine growth restriction, preterm delivery, venous thromboembolism), disease-related morbidity, maternal death, and a composite of neonatal morbidity. Outcomes were compared using chi-square, Fisher exact, Wilcoxon rank sum, and t tests. Odds of adverse outcomes were modeled with logistic regression.Results: Seventy-seven patients with SLE were included for analysis; 47 (61%) were treated with HCQ and 30 (39%) were not. We found no differences in the rates of maternal morbidities or death between groups. Patients taking HCQ had increased rates of disease-related hospitalizations (43% vs 7%, P<0.01) and inpatient rheumatology consultations (38% vs 10%, P<0.01), increases that persisted after multivariable adjustments (adjusted odds ratio [aOR] 8.09, 95% confidence interval [CI] 1.60-40.9; aOR 4.50, 95% CI 1.08-18.6, respectively). Neonatal morbidity did not differ between groups.Conclusion: We found no differences in major maternal or neonatal outcomes in pregnant patients with SLE managed with HCQ.
Highlights
Systemic lupus erythematosus (SLE) is one of the most common autoimmune diseases encountered during pregnancy, with approximately 4,500 women with SLE becoming pregnant annually.1-2 Women with SLE are at increased risk of adverse pregnancy outcomes
We hypothesized that HCQ use in pregnancy would not increase maternal or neonatal morbidities often encountered in patients with SLE
Our study suggests that HCQ does not have a significant effect—either positive or negative—on major maternal and neonatal outcomes in a predominantly African American population treated in a large tertiary center in the southern United States
Summary
Systemic lupus erythematosus (SLE) is one of the most common autoimmune diseases encountered during pregnancy, with approximately 4,500 women with SLE becoming pregnant annually. Women with SLE are at increased risk of adverse pregnancy outcomes. Continuing the use of HCQ, even during the first trimester, has not been associated with an increased risk for fetal anomalies.. Continuing the use of HCQ, even during the first trimester, has not been associated with an increased risk for fetal anomalies.1,2,5-9 As such, both the British Society for Rheumatology and the European League Against Rheumatism have recommended HCQ for the treatment of SLE during pregnancy.. Our objective was to compare maternal and neonatal outcomes in pregnant patients with SLE treated with and without HCQ at a tertiary care center in the United States. Key outcomes included maternal morbidities (hypertensive disorders, intrauterine growth restriction, preterm delivery, venous thromboembolism), disease-related morbidity, maternal death, and a composite of neonatal morbidity.
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