Article Text

Download PDFPDF

PS4:80 Hydroxychloroquine in lupus pregnancy: a meta-analysis of individual participant data
  1. A Eudy1,
  2. M Petri2,
  3. R Fischer-Betz3,
  4. A Mokbel4,
  5. C Nalli5,
  6. L Andreoli5,
  7. A Tincani5,
  8. Y Molad6,
  9. D Gladman7 and
  10. M Urowitz8
  1. 1Duke University Medical Centre – Department of Medicine, Durham, USA
  2. 2Johns Hopkins University School of Medicine – Department of Medicine, Baltimore, USA
  3. 3University Hospital Düsseldorf – Department of Rheumatology, Düsseldorf, Germany
  4. 4Cairo University Hospital – Department of Rheumatology and Rehabilitation, Cairo, Egypt
  5. 5Ospedali Civili and University of Brescia – Rheumatology and Clinical Immunology, Brescia, Italy
  6. 6Tel Aviv University – Rheumatology Unit, Tel Aviv, Israel
  7. 7University of Toronto – Rheumatology, Toronto, Canada
  8. 8University of Toronto – Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Canada


Purpose Our current knowledge about how to treat lupus in pregnancy derives from small prospective or retrospective cohorts. The goal of this individual participant meta-analysis was to pool data from multiple prospective cohorts to answer the clinical question of whether hydroxychloroquine (HCQ) treatment affects pregnancy outcomes

Methods The literature was searched for prospective cohorts of pregnancies among women with lupus. HCQ use was defined as use any time during pregnancy. Outcomes of interest included fetal loss, preterm birth, high disease, and preeclampsia. Data from each cohort were collected and analysed individually. Pooled ORs were calculated by random-effect models in Review Manager. Due to multiple pregnancies per patient, one pregnancy was randomly selected per patient. Primary analysis included only women with first trimester visits (6 cohorts). Subgroup analyses were stratified by a history of nephritis, APS, and disease activity at first clinic visit.

Results The current analysis included 591 pregnancies from six cohorts, of which 73% were exposed to HCQ during pregnancy.

Fetal loss: Overall, there was a 51% decrease in the risk of fetal loss among patients taking HCQ during pregnancy (OR: 0.49; 95% CI: 0.24 to 1.00). Among patients with a history of lupus nephritis, taking HCQ during pregnancy reduced the risk of fetal loss by 76% (OR: 0.24; 95% CI: 0.07 to 0.83; table 1).

Preterm birth: There was no evidence that HCQ decreased the risk of preterm birth.

Disease activity: Although not significant, among patients with a history of lupus nephritis, HCQ use during pregnancy may reduce the risk of having high disease activity during pregnancy (OR: 0.47; 95% CI: 0.21 to 1.09).

Preeclampsia: Overall, there was no evidence that HCQ decreased the risk of. Among patients with APS, there may be a protective effect of HCQ, but the precision of the estimate was limited (OR: 0.55; 95% CI: 0.12 to 2.45).

Conclusion Our results suggest that among patients with lupus nephritis, HCQ use may decrease the risk of fetal loss and decrease high disease activity during pregnancy. The heterogeneity of data collection suggests the need for a unified approach to identify larger cohorts of lupus pregnancies.

Abstract PS4:80 Table 1

Pooled odds ratios for the association of hydroxychloroquine use and pregnancy outcomes

  • Pregnancy
  • Hydroxychloroquine
  • Meta-analysis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.