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Pregnant women with aPL antibodies may benefit from hydroxychloroquine
Women with antiphospholipid syndrome or positive antiphospholipid antibodies who became pregnant while receiving hydroxychloroquine for at least 6 months were more likely to have positive pregnancy outcomes compared with patients who did not receive hydroxychloroquine, according to analysis of recently published data.
An observational, retrospective, single-center study of 170 pregnancies in 96 women with antiphospholipid antibodies (aPL) was conducted at a tertiary referral center. All women had positive aPL levels conformed at least 12 weeks apart prior to the index pregnancy.
Investigators collected clinical and serological data, including demographics, disease and pregnancy characteristics, the presence of systemic lupus erythematosus (SLE) or other comorbidities, risk factors for cardiovascular disease and autoantibody status. They also noted all medications, including aspirin and low-molecular-weight heparin (LMWH).
From January 2008 to July 2015, 31 women who received hydroxychloroquine for at least 6 months (group A) experienced 51 pregnancies. Of these women, 64.5% had SLE and 32.2% had primary antiphospholipid syndrome (APS). In 26 pregnancies, women received 200 mg hydroxychloroquine twice a day. In 25 pregnancies, mothers took 200 mg hydroxychloroquine once a day. Hydroxychloroquine was the only treatment aside from aspirin or LMWH received by 30 patients. Seven women were primigravida and 24 were multiparous.
A second group of 65 patients with aPL experienced 119 pregnancies and did not receive hydroxychloroquine (group B). In this group, 7.7% of patients had SLE, 69.2% of patients had primary APS and 23.1% had a positive aPL status with no prior disease events or indications to receive hydroxychloroquine.
Analysis showed pregnancy complications related to aPL status were reduced, and the number of live births were higher in patients who received hydroxychloroquine. Independent factors related to poor pregnancy outcomes included previous pregnancy morbidity (odds ratio of 12.1) and triple aPL positivity (odd ratio of 2.6). Pre-eclampsia, abruption placenta and intrauterine growth restriction was more common in group B (10.9%) compared with patients in group A (2%). The frequency of vaginal births was 37.3% in patients in group A compared with 14.3% of patients in group B. No thrombotic events occurred during the study period. – by Shirley Pulawski
Disclosure s : The researchers report no relevant financial disclosures.