Hydroxychloroquine in early pregnancy and preeclampsia and preterm delivery in systemic lupus erythematosus – A nationwide population-based cohort study
Abstract
Background: Pregnant individuals with systemic lupus erythematosus (SLE) have elevated risks of preeclampsia and preterm delivery. Hydroxychloroquine, the mainstay treatment in SLE pregnancy, is currently a promising agent for preeclampsia prevention. This nationwide population-based cohort study aimed to examine associations between hydroxychloroquine and preeclampsia and preterm delivery in SLE pregnancies. Methods: We included 959 singleton pregnancies from 685 women with prevalent SLE diagnosed in secondary or tertiary care centres in the entire country of Sweden (2007–2022). Hydroxychloroquine exposure was ≥2 dispensations from three months pre-pregnancy through the end of the first trimester. The primary outcomes were preeclampsia (diagnosed from gestational week (gw) 20+0 to six weeks post-partum) and preterm delivery (delivery before gw 37+0). Inverse probability of treatment weighting adjusted for measured confounders (e.g., maternal smoking, BMI, reproductive characteristics, pregestational hypertension, glucocorticoid use) and modified Poisson models estimated risk ratios and 95% confidence intervals (RR [95%CI]). We involved a person with lived experience in all aspects of the study. Findings: Preeclampsia risks in the hydroxychloroquine-exposed vs. unexposed groups were 19 (11%) of 172 vs. 30 (13%) of 232 (nulliparous) and 12 (5%) of 222 vs. 20 (6%) of 333 (parous), respectively. Preterm delivery risks (exposed vs. unexposed) were 19% vs. 16% (nulliparous) and…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 685 participants or records.
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