Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study

Leroux, M.; Desveaux, C.; Parcevaux, M; Julliac, B.; Gouyon, Jean‐Bernard; Dallay, D.; Pellegrin, JL; Boukerrou, Malik; Blanco, Patrick; Lazaro, Estibaliz

doi:10.1177/0961203315591027

Cited by 118 publications

(108 citation statements)

References 42 publications

(62 reference statements)

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“…Given its known safety profile in pregnancy [80,109], and the acknowledged risk to both mother and fetus associated with heightened lupus disease activity in pregnancy, discontinuing HCQ during pregnancy is not advised. Indeed, several studies have suggested that HCQ therapy in SLE improves birth outcomes: in a study of 118 lupus pregnancies in which 41 women were treated with HCQ and compared to 77 SLE women who were not taking HCQ, significantly lower rates of preterm delivery (15.8% vs 44.2%; p= 0.006) and IUGR (10.5% vs 28.6%; p=0.03) were observed in the group taking HCQ [29]. In another retrospective study of outcomes of lupus pregnancies, 56 women who took HCQ through their pregnancies were compared with 163 who took no HCQ, and 38 who stopped HCQ either three months prior to conception or during their first trimesters out of concern for medication exposure to the baby [30].…”

Section: Medications During Autoimmune Ctd Pregnanciesmentioning

confidence: 99%

Pregnancy and autoimmune connective tissue diseases

Marder

Littlejohn

Somers

2016

Best Practice & Research Clinical Rheumatology

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The autoimmune connective tissue diseases predominantly affect women and often occur during the reproductive years. Thus, specialized issues in pregnancy planning and management are commonly encountered in this patient population. This chapter provides a current overview of pregnancy as a risk factor for onset of autoimmune disease, considerations related to the course of pregnancy in several autoimmune connective tissue diseases, and disease management and medication issues before and during pregnancy and the postpartum period. A major theme that has emerged across these inflammatory diseases is that active maternal disease during pregnancy is associated with adverse pregnancy outcomes, and that maternal and fetal health can be optimized when conception is planned during times of inactive disease and through maintaining treatment regimens compatible with pregnancy.

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Section: Medications During Autoimmune Ctd Pregnanciesmentioning

confidence: 99%

Pregnancy and autoimmune connective tissue diseases

Marder

Littlejohn

Somers

2016

Best Practice & Research Clinical Rheumatology

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“…Active/flaring SLE at conception or in the 4e6 months before has also been associated with adverse pregnancy outcomes (APO) other than EPL: late pregnancy losses (LPL), neonatal death, preterm delivery/prematurity, hypertensive complications and probably intrauterine growth restriction (IUGR) and small for gestational age (SGA) newborns [16,22e27]. Even though the disease could be in remission at the time of conception, major organ involvements such as renal or neurological, should be considered as risk factors for APO [13,21,28,29].…”

Section: Maternal and Foetal Outcome In Sle Pregnancymentioning

confidence: 99%

A comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus

Lazzaroni

Dall’Ara

Fredi

et al. 2016

Journal of Autoimmunity

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“…HCQ use during pregnancy prior to 2000 was not common practice, but increasing reports of its safety and efficacy during pregnancy have since changed prescribing patterns. [18] In our study, HCQ use either prior or during pregnancy was not related to pregnancy outcome, nor was year of conception (pre- vs. post-2006).…”

Section: Discussionmentioning

confidence: 52%

Organ-specific systemic lupus erythematosus activity during pregnancy is associated with adverse pregnancy outcomes

et al. 2016

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BACKGROUND Systemic lupus erythematosus (SLE) is a disease of reproductive-age women and thus questions regarding how disease influences pregnancy outcomes arise. We investigated whether five specific types of SLE activity during the six months before conception or during pregnancy (nephritis, cytopenias, skin disease, arthritis, serositis) were associated with adverse pregnancy outcomes. METHODS We performed a retrospective cohort study of pregnancy outcomes among women with SLE at the Brigham and Women's Hospital Lupus Center. Adverse pregnancy outcomes included pre-eclampsia, preterm delivery, elective termination due to SLE, spontaneous miscarriage at weeks 12–20, and stillbirth. SLE and obstetric history, laboratories, and medications were obtained from electronic medical records. Generalized linear mixed models adjusting for potential confounders were used to identify predictors of any adverse pregnancy outcome. RESULTS Most pregnancies resulted in a live, term delivery (76.5%). After adjustment for Hispanic ethnicity, prior adverse pregnancy outcome and medication use six months before conception, nephritis during pregnancy (OR 3.6, 95% CI [1.0–12.8]), cytopenias during pregnancy (OR 3.9, 95% CI [1.3–11.4]), and serositis during pregnancy (OR 5.9, 95%CI [1.0–34.0]) were significantly associated with adverse pregnancy outcome. CONCLUSIONS Specific types of SLE disease activity during pregnancy were related to adverse pregnancy outcome. Nephritis, cytopenias and serositis carried a higher risk of adverse pregnancy outcome, suggesting that these abnormalities should be carefully monitored during pregnancy.

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Impact of hydroxychloroquine on preterm delivery and intrauterine growth restriction in pregnant women with systemic lupus erythematosus: a descriptive cohort study

Abstract: HCQ reduces neonatal morbidity in women with SLE by significantly decreasing the rate of prematurity and intrauterine growth restriction.

Cited by 118 publications

References 42 publications

Pregnancy and autoimmune connective tissue diseases

Pregnancy and autoimmune connective tissue diseases

A comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus

Organ-specific systemic lupus erythematosus activity during pregnancy is associated with adverse pregnancy outcomes

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