The use of hydroxychloroquine in pregnancy and its effect on perinatal outcomes in a population with autoimmune abnormalities

Ye, Sheng‐Long; Zhao, Xueqing; Liu, Yuanying; Ma, Yue; Wang, Yongqing; Zhao, Jinxia

doi:10.1007/s10067-022-06462-y

Cited by 5 publications

(4 citation statements)

References 35 publications

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“…An increasing number of studies have demonstrated that the administration of pregnancy-safe medications to reduce disease activity from the first trimester onwards can significantly reduce the rate of miscarriage, prevent the development of adverse fetal complications and improve the outcome of live births. [ 61 , 62 ] Hydroxychloroquine has been found to be an effective antiplatelet and immunomodulatory effects, [ 63 ] which improves hypercoagulability in RA circulation and reduces placental microthrombosis. [ 64 ] Other trials have demonstrated that low-molecular heparin and low-dose aspirin are up to 80% effective in improving live birth outcomes in pregnant women with RA, [ 65 ] and women with thrombotic manifestations require targeted anticoagulation to maintain homeostatic levels during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Causal association between rheumatoid arthritis and pregnancy loss and intrauterine growth retardation: A bidirectional two-sample Mendelian randomization study

Guo,

Diao,

Wang

et al. 2024

Medicine

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Objective: To investigate the causal relationship between rheumatoid arthritis (RA) and pregnancy loss and intrauterine growth retardation (IUGR) using Mendelian randomization (MR). Methods: Genetic variants associated with RA (12,555 cases and 240,862 controls), miscarriage (1475 cases and 149,622 controls), and IUGR (3558 cases and 207,312 controls) were obtained from the FinnGen consortium, and supplementary data on RA (5201 cases and 457,732 controls) and miscarriage (7069 cases and 250,492 controls) were obtained from the Medical Research Council Integrated Epidemiology Unit (MRC-IEU). 47 Single nucleotide polymorphisms (SNPs) associated with RA were screened as instrumental variables (IV). The causal relationship between RA and pregnancy loss and IUGR were assessed by 5 MR methods, mainly inverse variance weighting (IVW). Sensitivity analyses were also performed to test the stability of the results. Results: Bidirectional MR showed that genetically predicted RA was causally associated with pregnancy loss and IUGR in forward MR analyses, and that RA significantly increased pregnancy loss [odds ratio (OR) = 1.13, 95% confidence interval (CI): 1.00–1.33, P = .03] and IUGR (OR = 1.08, 95% CI: 1.01–1.15, P = .019). In the reverse MR, there was no causal association between pregnancy loss (P = .15) and IUGR (P = .87) and RA. Conclusion: This study found a significant genetic association between RA and pregnancy loss and IUGR. RA is considered to be a high-risk factor for adverse maternal outcomes. Pre-pregnancy prophylaxis and intra-pregnancy control of patients should be emphasized to reduce the incidence of adverse pregnancy outcomes such as pregnancy loss and IUGR.

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Section: Discussionmentioning

confidence: 99%

Causal association between rheumatoid arthritis and pregnancy loss and intrauterine growth retardation: A bidirectional two-sample Mendelian randomization study

Guo,

Diao,

Wang

et al. 2024

Medicine

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“…Research has indicated that the use of HCQ during pregnancy significantly reduces the incidence of pre-eclampsia, early-onset pre-eclampsia and mid-to-late pregnancy fetal loss in individuals with autoimmune diseases. 24 HCQ, currently recognised as a non-specific anti-inflammatory agent, functions by accumulating in the cell cytoplasm, thereby inhibiting autophagy and regulating intracellular homeostasis. It can also exert anti-inflammatory effects by inhibiting toll-like receptors, inflammatory factors, and complement responses.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of adverse gestational outcomes in pregnant women with primary Sjögren’s syndrome

Tan,

Shao,

Zhou

et al. 2024

RMD Open

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ObjectivesThis study aimed to identify risk factors contributing to diverse pregnancy outcomes in primary Sjögren’s syndrome (pSS) cases.MethodsA retrospective analysis was conducted on pregnant individuals with pSS, who received outpatient or inpatient care across multiple hospitals in Anhui Province, China, from January 2015 to December 2022.ResultsThis study included 164 pregnant women with pSS and 328 control subjects, with no statistically significant difference in average age between the two groups. Analysis of pregnancy outcomes revealed that, compared with the control group, pregnant women in the pSS group were more likely to experience miscarriages, both spontaneous (12.80% vs 1.52%, p<0.001) and therapeutic (6.10% vs 0.91%, p<0.05). The proportion of placental abnormalities detected during prenatal ultrasound in women from the pSS group was higher (14.63% vs 6.40%, p<0.05). In the analysis of pregnancy outcomes for live-born neonates, a higher incidence of congenital heart abnormalities was observed in the pSS group (27.34% vs 12.03%, p<0.05). While there were no significant differences between the pSS pregnancies in terms of both normal and adverse pregnancy outcomes, a comparison of fetal survival and fetal loss in pSS pregnancies revealed a greater use of prophylactic anticoagulant therapy in the fetal survival group. Notably, the application of low molecular weight heparin (LMWH) emerged as an independent protective factor for fetal survival.ConclusionsCompared with non-autoimmune controls, pregnancy in women with pSS presents more challenges. Importantly, we observed that the use of LMWH as anticoagulant therapy is an independent protective measure for fetal survival.

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“…HCQ ameliorates microbiota dysbiosis in patients with SS [ 71 ]. For pregnant women with autoimmune diseases, including SS, treatment with HCQ has been reported to improve perinatal outcomes, and early introduction by 3–6 months before pregnancy is recommended due to its slow-acting characteristics [ 72 ]. However, administration of HCQ to patients with SS has not been proven to improve sicca symptoms, pain, and fatigue in a previous randomized clinical trial, which concluded that further long-term analyses are needed [ 73 ].…”

Section: Future Therapeutic Perspectives On Ss Based On Viral Infecti...mentioning

confidence: 99%

Current Views on Pathophysiology and Potential Therapeutic Targets in Sjögren’s Syndrome: A Review from the Perspective of Viral Infections, Toll-like Receptors, and Long-Noncoding RNAs

Horai,

Shimizu,

Umeda

et al. 2023

JCM

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Sjögren’s syndrome (SS) is a rheumatic disease characterized by sicca and extraglandular symptoms, such as interstitial lung disease and renal tubular acidosis. SS potentially affects the prognosis of patients, especially in cases of complicated extraglandular symptoms; however, only symptomatic therapies against xerophthalmia and xerostomia are currently included in the practice guidelines as recommended therapies for SS. Considering that SS is presumed to be a multifactorial entity caused by genetic and environmental factors, a multidisciplinary approach is necessary to clarify the whole picture of its pathogenesis and to develop disease-specific therapies for SS. This review discusses past achievements and future prospects for pursuing the pathophysiology and therapeutic targets for SS, especially from the perspectives of viral infections, toll-like receptors (TLRs), long-noncoding RNAs (lncRNAs), and related signals. Based on the emerging roles of viral infections, TLRs, long-noncoding RNAs and related signals, antiviral therapy, hydroxychloroquine, and vitamin D may lower the risk of or mitigate SS. Janus-kinase (JAK) inhibitors are also potential novel therapeutic options for several rheumatic diseases involving the JAK-signal transducer and activator of transcription pathways, which are yet to be ascertained in a randomized controlled study targeting SS.

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The use of hydroxychloroquine in pregnancy and its effect on perinatal outcomes in a population with autoimmune abnormalities

Cited by 5 publications

References 35 publications

Causal association between rheumatoid arthritis and pregnancy loss and intrauterine growth retardation: A bidirectional two-sample Mendelian randomization study

Causal association between rheumatoid arthritis and pregnancy loss and intrauterine growth retardation: A bidirectional two-sample Mendelian randomization study

Increased risk of adverse gestational outcomes in pregnant women with primary Sjögren’s syndrome

Current Views on Pathophysiology and Potential Therapeutic Targets in Sjögren’s Syndrome: A Review from the Perspective of Viral Infections, Toll-like Receptors, and Long-Noncoding RNAs

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