Fetal outcomes and associated factors of adverse outcomes of pregnancy in southern Chinese women with systemic lupus erythematosus

Zhan, Zhi-Hui; Yang, Ying; Zhan, Yong; Chen, Dongying; Liang, Liuqin; Yang, Xia

doi:10.1371/journal.pone.0176457

Cited by 40 publications

(52 citation statements)

References 29 publications

(31 reference statements)

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“…HCQ is proven to be safe and effective in treating the immunological impairment and chronic endothelial dysfunction of pregnant women with SLE. In a recent study of 251 SLE patients with 263 pregnancies, HCQ was associated with a lower risk (OR = 0.3, 95% CI = 0.1–0.7, P = 0.01) of adverse pregnancy outcomes (stillbirth, premature birth, IUGR). Since 1983, case reports and case series on HCQ use during pregnancy and breast‐feeding have not reported an increased incidence of abnormalities in fetal outcomes or in early childhood development .…”

Section: Safety Of Hcq In Pregnancymentioning

confidence: 96%

“…Since 1983, case reports and case series on HCQ use during pregnancy and breast‐feeding have not reported an increased incidence of abnormalities in fetal outcomes or in early childhood development . Given the reported safety profile of HCQ in pregnancy, there has been a rise in HCQ use during pregnancy in the past 13 years (from 6.3% in 2005 to 60.9% in 2017) …”

Section: Safety Of Hcq In Pregnancymentioning

confidence: 99%

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Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage

Moreuil

Alavi

Pasquier

2019

Brit J Clinical Pharma

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Recurrent miscarriage (RM) and vasculoplacental disorders, such as preeclampsia (PE), affect women of childbearing age worldwide. Vascular endothelial dysfunction and immunological impairment are associated with both RM and PE. To date, there is no effective or optimal therapeutic approach for these conditions. Notably, aspirin use is only partially effective in the prevention of PE. Hydroxychloroquine (HCQ) has demonstrated beneficial effects on disease flares, pregnancy outcomes and cardiovascular impairment in systemic erythaematosus lupus (SLE) through its immunomodulatory, vasculoprotective and antithrombotic properties. Here, in the context of the underlying physiological dysregulation associated with PE and RM, the beneficial properties and potential therapeutic efficacy of HCQ are reviewed in anticipation of the results of current and future trials. Two related trials addressing RM in the absence of maternal autoimmune disease are ongoing. Other trials addressing pregnancy outcomes in the presence of maternal autoimmune disease are forthcoming. In this review, we hypothesise that the immunological and endothelial effects of HCQ may be beneficial in the context of PE and RM, regardless of the maternal autoimmune status. K E Y W O R D S hydroxychloroquine, pregnancy, preeclampsia, recurrent miscarriage

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Section: Safety Of Hcq In Pregnancymentioning

confidence: 96%

Section: Safety Of Hcq In Pregnancymentioning

confidence: 99%

Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage

Moreuil

Alavi

Pasquier

2019

Brit J Clinical Pharma

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“…in contemporary studies. [8][9][11][12]29,[54][55][60][61][62][63] In addition, a recently published Canadian study showed that the use of antimalarial drugs was stopped in up to 30% of patients during pregnancy. That is why we believe that our results reinforce the importance of maintaining antimalarial drugs during pregnancy.…”

Section: F I G U R E 1 Kaplan-mentioning

confidence: 99%

Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study

et al. 2020

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Introduction: Several factors have been associated with the development of preeclampsia in women with systemic lupus erythematosus (SLE). Objective:To identify risk factors associated with preeclampsia in patients with SLE and its impact on fetal outcomes. Patients and methods:We studied a prospective cohort of pregnancies in women with SLE from January 2009 to December 2018. Demographic, clinical, serological and drug use characteristics were compared between patients who developed preeclampsia and those who did not, as well as the main neonatal outcomes. An adjusted logistic regression analysis was performed to identify factors potentially associated with preeclampsia. Results:We studied 316 pregnancies of 20 or more weeks of gestation. A total of 46 pregnancies (14.5%) were complicated by preeclampsia. A higher frequency of active disease before pregnancy (24.4% vs 11.3%, P = .01) and history of lupus nephritis (56.5% vs 30.1%, P < .001) were found in those patients who developed preeclampsia compared to those who did not. Preeclampsia was associated with a higher rate of prematurity, births of very low birth weight, stillbirth, and neonatal death. The multivariate analysis showed that the activity of the disease before (relative risk [RR] 2.7, 95% CI 1.04-7.4, P = .04) and during pregnancy (RR 3.0, 95% CI 1.0-9.1, P = .04) was associated with the development of preeclampsia. The use of antimalarial drugs during pregnancy was associated with a lower risk of preeclampsia (RR 0.21, 95% CI 0.08-0.53, P < .001). Conclusions:Our study suggests that the use of antimalarial drugs during pregnancy reduces the risk of preeclampsia in lupus pregnancies. K E Y W O R D Santimalarials, preeclampsia, pregnancy, systemic lupus erythematosus

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“…It is an acquired autoimmune passive disease mediated by maternal antibodies, reported in about 1-2% of infants born to mothers with autoimmune disease with Anti-Ro/SSA, and Anti-La/SSB antibodies [25]. However, some cases occur in children of mothers who have the same autoantibodies but have no symptoms of SLE, and no other autoimmune disease during pregnancy [27]. The pathogenesis of the disease is not completely clear, but is likely to be greater than the simple passage of paired antibodies.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Positive Anti-Ro/SSA and Anti-La/SSB Antibodies Among Infants with Prolonged Skin Lesions and Its Relation to Autoimmune Disease in the Mother

Makhlouf¹

2018

IJI

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Many literatures reported that neonatal lupus erythematosus and its associated abnormalities mainly, cutaneous lupus lesions, congenital heart block (CHB), hematologic cytopenias, hepatobiliary disease and cardiomyopathy are associated with anti-Ro/SSA and anti-La/SSB antibodies. With skin findings occur in nearly 95% of NLE infants, others reported that 100% of NLE infants with CHB were positive for anti Ro/SSA antibodies and 90.2% of infants with skin NLE were positive for anti Ro/SSA. And long-term follow-up of children with neonatal lupus and their unaffected siblings revealed that 12.24% of NLE children identified definite rheumatic/autoimmune diseases after more than 8 years. Aim of the study: The aim of this study was to determine the incidence of positive anti-Ro/SSA and anti-La/SSB antibodies in infants with recurrent prolonged skin lesions and their mothers to determine asymptomatic mothers at risk to develop autoimmune disease. Subjects and methods: a total of 90 infants with recurrent prolonged skin lesions below the age of 6 months and their mothers attending pediatric screening and follow up clinic at Al Galaa Teaching Hospital in Cairo, Egypt were investigated for positivity of anti Ro/SSA and anti La/SSB antibodies using enzyme linked immunoassay (ELISA). Results: Incidence rate of positive anti Ro/SSA alone and anti La/SSB alone antibodies in infants were 34.4% and 23.3% respectively, and positive both anti Ro/SSA and anti La/SSB antibodies was 21.1%, while in their mothers, positive both anti Ro/SSA and anti La/SSB antibodies was 36.7%. Among the 33 cases with positive antibodies female: male ratio was 2.3:1, and rheumatologic and autoimmune diseases was positive in 14 (42.4%) mothers, while, 19 (57.6%) were asymptomatic mothers, anemia, lymphocytosis, neutropenia with relative lymphocytosis, eosinophilia and thrombocytopenia were found in 6.1%, 9.1%, 3.0%, 9.1% and 12.1% respectively. Liver transaminases were elevated in 4 (12.1%). Positive anti Ro/SSA and anti La/SSB antibodies were statistically significantly correlated with infant age, body weight, body length and head circumference, female sex, infants mothers' rheumatologic and autoimmune diseases, distribution of skin lesions, positive history of steroid containing cream use, and thrombocytopenia. However, both antibodies showed no statistically significant correlation with infant feeding, rate of recurrent skin lesions, anemia, lymphocytosis, neutropenia with relative lymphocytosis, eosinophilia, positive CRP, and elevated ESR. Conclusion: our infant cases with prolonged skin lesions with positive anti Ro/SSA and anti La/SSB antibodies with their mothers' especially asymptomatic ones should be investigated and followed up properly for development of NLE and autoimmune diseases.

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Fetal outcomes and associated factors of adverse outcomes of pregnancy in southern Chinese women with systemic lupus erythematosus

Cited by 40 publications

References 29 publications

Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage

Hydroxychloroquine may be beneficial in preeclampsia and recurrent miscarriage

Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study

Incidence of Positive Anti-Ro/SSA and Anti-La/SSB Antibodies Among Infants with Prolonged Skin Lesions and Its Relation to Autoimmune Disease in the Mother

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