Hydroxychloroquine in lupus pregnancy
Hydroxychloroquine in lupus pregnancy
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DOI：
10.1002/art.22159
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发表时间：
2006-11-01
影响因子：
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通讯作者：
Petri, Michelle
中科院分区：
文献类型：
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作者：
Clowse, Megan E. B.;Magder, Laurence;Petri, Michelle
Objective.妊娠期系统性红斑狼疮（SLE）患者经常需要使用羟氯喹（HCQ）来控制疾病活动。本研究的目的是检查妊娠期SLE患者接受或未接受HCQ治疗的狼疮活动性和妊娠结局。这是一项对1987年至2002年期间接受评估的SLE女性妊娠的前瞻性研究。将妊娠分为3组：妊娠期间无HCQ暴露（163例妊娠），妊娠期间连续使用HCQ（56例妊娠），或在妊娠前3个月或妊娠前三个月停止HCQ治疗（38例妊娠）。比较各组妊娠结局、胎儿结局及妊娠期狼疮活动情况。流产、死胎、妊娠丢失和先天畸形的发生率在3组之间无统计学差异。然而，妊娠期间狼疮活动的程度在停止服用HCQ的女性中显着更高。这些妇女有更高程度的狼疮活动，如通过医生对狼疮活动和SLE疾病活动指数的估计所测量的，以及在怀孕期间增加的发作率。更严重的狼疮并发症，如蛋白尿和血小板减少症，在停止服用HCQ的女性中并没有显着增加。继续服用HCQ的妇女在妊娠期间维持较低的泼尼松平均剂量。我们建议在怀孕期间继续使用HCQ治疗。我们的研究结果与之前关于无胎儿毒性的报道一致。与非妊娠妇女的研究相似，妊娠期间停止HCQ治疗会增加狼疮活动的程度。
Objective. Hydroxychloroquine (HCQ) is often needed to manage disease activity in systemic lupus erythematosus (SLE) during pregnancy. The purpose of this study was to examine lupus activity and pregnancy outcomes in women with SLE treated or not treated with HCQ during pregnancy.Methods. This was a prospective study of pregnancies in women with SLE who were evaluated between 1987 and 2002. The pregnancies were divided into 3 groups: no HCQ exposure during pregnancy (163 pregnancies), continuous use of HCQ during pregnancy (56 pregnancies), or cessation of HCQ treatment either in the 3 months prior to or during the first trimester of pregnancy (38 pregnancies). The pregnancy outcomes, fetal outcomes, and lupus activity during pregnancy were compared among these groups.Results. The rates of miscarriage, stillbirth, pregnancy loss, and congenital abnormality were not statistically different among the 3 groups. The degree of lupus activity during pregnancy' however, was significantly higher in women who stopped taking HCQ. These women had a higher degree of lupus activity, as measured by the physician's estimate of lupus activity and the SLE Disease Activity Index, as well as an increased rate of flare, during pregnancy. More serious lupus complications, such as proteinuria and thrombocytopenia, were not significantly higher in women who stopped taking HCQ. Women who continued taking HCQ were maintained on a lower average dose of prednisone during pregnancy.Conclusion. We recommend the continuation of HCQ treatment during pregnancy. Our findings are consistent with prior reports of the absence of fetal toxicity. Similar to studies of nonpregnant women, the cessation of HCQ treatment during pregnancy increases the degree of lupus activity.