羟氯喹与患有系统性红斑狼疮的不同女性群体中的先兆子痫

IF 3.7 2区 医学 Q1 RHEUMATOLOGY
Julia F. Simard, Emily F. Liu, Amadeia Rector, Miranda Cantu, Eliza Chakravarty, Maurice Druzin, Daniel Z. Kuo, Gary M. Shaw, Michael Weisman, Monique Hedderson
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引用次数: 0

摘要

目的:系统性红斑狼疮(SLE)患者有妊娠并发症(如子痫前期和子痫)的风险。这些临床上重要的并发症与产妇的发病率、死亡率和产后心血管疾病有关。一些研究表明,羟氯喹(HCQ)可降低狼疮妊娠先兆子痫的风险。我们利用北加州凯撒医疗中心(KPNC)的一组系统性红斑狼疮患者的妊娠资料,研究了在妊娠早期使用羟氯喹是否会降低先兆子痫/子痫的风险:在 2011-2020 年间的系统性红斑狼疮孕妇中,我们评估了从孕前三个月到妊娠头三个月使用 HCQ 的情况。HCQ暴露有多种定义方式,以考虑依从性和使用持续时间。倾向评分考虑了多种混杂因素,修正泊松模型估算了HCQ与子痫前期/子痫之间的风险比(RR)和95%置信区间。通过分层分析研究了妊娠高血压、肾炎病史和抗磷脂抗体状态对影响的影响:2011年至2020年期间,324名系统性红斑狼疮患者在KPNC妊娠399例。考虑到多种暴露定义,我们一致发现 HCQ 与先兆子痫/子痫之间呈负相关。在无先兆子痫妊娠中,RRs一直较低,而在有肾炎病史、aPL阳性或妊娠前高血压的高风险亚组(包括无先兆子痫和多胎妊娠)中,RRs一直具有保护作用,但无统计学意义:讨论:尽管本研究发现 HCQ 并未降低子痫前期/子痫的风险,但在综合医疗保健服务系统中,尽管有详细的临床数据,但残留的混杂因素可能会削弱其效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hydroxychloroquine and Pre-eclampsia in a Diverse Cohort of Women With Systemic Lupus Erythematosus

Objective

Patients with systemic lupus erythematosus (SLE) are at risk for pregnancy complications such as pre-eclampsia and eclampsia. These clinically important complications are associated with maternal morbidity, mortality, and postpartum cardiovascular disease. Some studies suggest that hydroxychloroquine (HCQ) may reduce pre-eclampsia risk in lupus pregnancy. Using a cohort of pregnant patients with prevalent SLE at Kaiser Permanente Northern California (KPNC), we investigated whether HCQ treatment in early pregnancy reduced the risk of pre-eclampsia or eclampsia.

Methods

Among pregnant patients with SLE from 2011 to 2020, we assessed HCQ treatment from three months before pregnancy through the first trimester. HCQ exposure was defined multiple ways to account for adherence and duration of treatment. Propensity scores accounted for multiple confounders and modified Poisson models estimated risk ratios (RRs) and 95% confidence intervals of the association between HCQ treatment and pre-eclampsia or eclampsia. Effect modification by pregestational hypertension, history of nephritis, and antiphospholipid antibody (aPL) status was investigated through stratified analysis.

Results

There were 399 pregnancies among 324 patients with SLE at KPNC between 2011 and 2020. Considering multiple exposure definitions, we consistently found a null association between HCQ and pre-eclampsia or eclampsia. The RRs were consistently lower among nullipara patients, and RRs were consistently protective but not statistically significant among the high-risk subgroup of patients with a history of nephritis, aPL positivity, or pregestational hypertension (for both nullipara and multipara patients).

Conclusion

Although this study found no reduced risk of HCQ on pre-eclampsia or eclampsia, residual confounding may be attenuating the effect despite an integrated health care delivery system setting with detailed clinical data.

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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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