Risk of preterm delivery and early pregnancy hydroxychloroquine use from a Californian lupus cohort.

IF 3.5 2区 医学 Q1 RHEUMATOLOGY
Amadeia Rector, Emily F Liu, Maurice Druzin, Michael H Weisman, Eliza Chakravarty, Miranda Cantu, Gary M Shaw, Daniel Z Kuo, Monique M Hedderson, Julia F Simard
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引用次数: 0

Abstract

Objective: Pregnant patients with systemic lupus erythematosus (SLE) have 2-3 times higher risk of preterm delivery (PTD). Hydroxychloroquine (HCQ) is recommended during pregnancy and may reduce PTD risk. This study investigates whether early pregnancy HCQ-use reduces PTD risk in a diverse SLE cohort.

Methods: We included singleton pregnancies reaching ≥20 weeks' gestation (2011-2020) among patients with SLE aged 18-50 receiving care at Kaiser Permanente Northern California. HCQ exposure was defined as ≥2 prescriptions filled from 3 months before the last menstrual period through the first trimester. PTD was defined as delivery <37 weeks and continuously as gestational weeks for time-to-delivery analyses. Propensity scores (PS) based on demographics, comorbidities and medication use were calculated to address confounding. Risk ratios (RR) and HRs, including 95% CIs, were estimated using PS-adjusted Poisson regression with robust SEs and Cox regression, stratified by parity. To investigate effect modification, we stratified by prepregnancy comorbidities and pregnancy corticosteroid use.

Results: Among 399 pregnancies in 324 patients, 21% were preterm. The PS-adjusted RR was 1.08 (95% CI 0.52 to 2.23) and 0.88 (95% CI 0.50 to 1.57) for nulliparous and multiparous pregnancies exposed to HCQ, respectively. The PS-adjusted HRs were similar, and results remained consistent across analyses stratified by potential effect modifiers.

Conclusions: Although periconceptional HCQ-use was not associated with reduced PTD nor appreciably altered gestational age at delivery, we found no increased risks for these specific adverse outcomes. Consistent with other work, we found potentially protective associations in subsets stratified by parity. However, we had limited statistical power to test this.

加利福尼亚狼疮患者使用羟氯喹的早产和早孕风险
目的:系统性红斑狼疮(SLE)孕妇发生早产(PTD)的风险高2-3倍。羟氯喹(HCQ)建议在怀孕期间,可以降低PTD的风险。本研究调查了妊娠早期使用hcq是否能降低不同SLE队列的PTD风险。方法:我们纳入了在Kaiser Permanente北加州接受治疗的18-50岁SLE患者中妊娠≥20周的单胎妊娠(2011-2020年)。HCQ暴露定义为从最后一次月经前3个月到妊娠早期服用≥2个处方。PTD定义为分娩结果:在324例患者的399例妊娠中,21%早产。暴露于HCQ的未产和多产妊娠,经ps校正的RR分别为1.08 (95% CI 0.52 ~ 2.23)和0.88 (95% CI 0.50 ~ 1.57)。ps调整后的hr相似,并且在按潜在效应修饰因子分层的分析中结果保持一致。结论:尽管围孕期使用hcq与PTD的降低和分娩时胎龄的明显改变无关,但我们发现这些特定不良结局的风险没有增加。与其他工作一致,我们发现按产次分层的亚群中存在潜在的保护性关联。然而,我们的统计能力有限,无法对此进行检验。
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来源期刊
Lupus Science & Medicine
Lupus Science & Medicine RHEUMATOLOGY-
CiteScore
5.30
自引率
7.70%
发文量
88
审稿时长
15 weeks
期刊介绍: Lupus Science & Medicine is a global, peer reviewed, open access online journal that provides a central point for publication of basic, clinical, translational, and epidemiological studies of all aspects of lupus and related diseases. It is the first lupus-specific open access journal in the world and was developed in response to the need for a barrier-free forum for publication of groundbreaking studies in lupus. The journal publishes research on lupus from fields including, but not limited to: rheumatology, dermatology, nephrology, immunology, pediatrics, cardiology, hepatology, pulmonology, obstetrics and gynecology, and psychiatry.
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