Systemic lupus erythematosus: Perinatal outcomes in patients treated with and without hydroxychloroquine

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease commonly encountered during pregnancy. The use of hydroxychloroquine (HCQ) for SLE treatment in pregnancy has been supported by a few small studies performed in populations dissimilar from populations in the United States. Our objective was to compare maternal and neonatal outcomes in pregnant patients with SLE treated with and without HCQ at a tertiary care center in the United States. Methods: We conducted a retrospective cohort study of patients with SLE and singleton gestations who delivered at the University of Alabama at Birmingham from 2006 to 2013. Patients treated with HCQ during pregnancy were compared with patients who did not receive HCQ. Key outcomes included maternal morbidities (hypertensive disorders, intrauterine growth restriction, preterm delivery, venous thromboembolism), disease-related morbidity, maternal death, and a composite of neonatal morbidity. Outcomes were compared using chi-square, Fisher exact, Wilcoxon rank sum, and t tests. Odds of adverse outcomes were modeled with logistic regression. Results: Seventy-seven patients with SLE were included for analysis; 47 (61%) were treated with HCQ and 30 (39%) were not. We found no differences in the rates of maternal morbidities or death between groups. Patients taking HCQ had increased rates of disease-related hospitalizations (43% vs 7%, P<0.01) and inpatient rheumatology consultations (38% vs 10%, P<0.01), increases that persisted after multivariable adjustments (adjusted odds ratio [aOR] 8.09, 95% confidence interval [CI] 1.60-40.9; aOR 4.50, 95% CI 1.08-18.6, respectively). Neonatal morbidity did not differ between groups. Conclusion: We found no differences in major maternal or neonatal outcomes in pregnant patients with SLE managed with HCQ.