Impact of hydroxychloroquine on the gestational outcomes of pregnant women with immune system problems that necessitate the use of the drug

Abstract

Aim: To evaluate the impact of hydroxychloroquine (HCQ) on the perinatal outcomes of pregnancies with immune system disorders that necessitate the use of the drug. Methods: This cohort consisted of 202 pregnancies with poor obstetric history and immune system problems. Patients enrolled in special antenatal care program were administered low-dose low-molecular-weight heparin, low-dose salicylic acid and low-dose corticosteroid (prophylaxis protocol) as soon as their pregnancies were confirmed. Pregnancies with systemic lupus erythematosis, Sjogren syndrome and rheumatoid arthritis were additionally administered HCQ 200 mg daily as a part of their routine treatment. Pregnancies using HCQ were included in the study group (n = 39) while the remainders were included in control group (n = 163). We compared the groups in terms of the presence of miscarriage, fetal growth restriction (FGR), preeclampsia and preterm birth, as well as gestational week at birth, birthweight and "APGAR score of <7" at 10th minute. Results: Miscarriage rates were 28.2% and 28.2% while preterm birth rates were 16.6% and 28.2% in the control and study groups, respectively (P = 0.215). Preeclampsia and HCQ-related side effects were not detected in the groups. There were also no significant differences between the groups in terms of FGR, gestational day at birth, birthweight and the presence of "APGAR score <7" at 10th minute (P = 0.462, P = 0.064, P = 0.273 and P = 0.627, respectively). Conclusion: Low-dose low-molecular-weight heparin, low-dose salicylic acid and low-dose corticosteroid prophylaxis together with HCQ seem to be promising in pregnancies with immune system disorders. HCQ seems to be a safe and effective drug in low dosages.

Sjögren’s syndrome and pregnancy: a Portuguese case-control study

“…In our study, a high percentage of patients were medicated with HCQ. Hydroxychloroquine treatment might have a positive effect on the perinatal outcomes [20], which may also could support our findings.…”

Hydroxychloroquine reduces soluble Flt-1 secretion from human cytotrophoblast, but does not mitigate markers of endothelial dysfunction in vitro

“…These factors and cytokines are also highly active in preeclamptic placentas and likely contribute to the progression of the disease. Importantly, several clinical studies have demonstrated that hydroxychloroquine posed no increased risk in pregnancy related complications in women with auto-immune conditions, albeit a higher observation of preterm births that was attributed to underlying disease activity, rather than the drug [ 13 – 15 ]. Furthermore, hydroxychloroquine was not found to pose a serious risk to congenital and developmental progress.…”

British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids

“…Despite these limitations, there were no appreciable adverse effects of HCQ on pregnancy duration or birth weight in the largest studies. In fact, several studies comparing HCQ-treated and untreated cohorts with rheumatic disease (mostly SLE) either found no significant difference between cohorts [17,19,21,24,28,34,36,37], or significantly longer pregnancy durations and/or higher birth weight in the HCQtreated pregnancies [18,20,22,25,27,29,30,32,33,35].…”

“…Despite these limitations, there were no appreciable adverse effects of HCQ on pregnancy duration or birth weight in the largest studies. In fact, several studies comparing HCQ-treated and untreated cohorts with rheumatic disease (mostly SLE) either found no significant difference between cohorts [ 17 , 19 , 21 , 24 , 28 , 34 , 36 , 37 ], or significantly longer pregnancy durations and/or higher birth weight in the HCQ-treated pregnancies [ 18 , 20 , 22 , 25 , 27 , 29 , 30 , 32 , 33 , 35 ]. The weighted mean for gestation across 15 studies reporting pregnancy duration in HCQ-exposed vs HCQ-unexposed pregnancies was 36.4 weeks and 34.7 weeks, respectively [ 18–21 , 24 , 27 , 28 , 30 , 32–34 , 36 , 37 , 43 , 49 ].…”