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Hydroxychloroquine significantly decreases the risk of preeclampsia in pregnant women with autoimmune disorders: a systematic review and meta-analysis

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Abstract

This meta-analysis aimed to investigate whether hydroxychloroquine (HCQ) intervention could decrease the incidence of preeclampsia and other maternal and fetal outcomes among pregnant women with autoimmune disorders. PubMed, EMBASE, Web of Science, and the Cochrane databases were searched from inception until January 2022. Data on maternal or fetal outcomes of the control and hydroxychloroquine treatment groups were gathered and analyzed. Pooled odds ratio (OR) with 95% confidence intervals (CIs) were determined. Cochran’s Q test, I2 statistics, leave-one-out analysis, Baujat plot analysis, GOSH plot analysis, and multivariable meta-regression were applied to assess between-study heterogeneity. The meta-analysis was performed using the Stata V.16.1 software. Baujat plot analysis and GOSH plot analysis were performed using the R V.4.0.0 software. Our study included 21 cohort studies and one case–control study with a total of 3948 pregnancies with immune disorders. HCQ treatment significantly reduced the incidence of preeclampsia (OR 0.45, 95% CI 0.33–0.63, p = 0.000, I2 3.68%). After outlier omission, HCQ treatment significantly reduced the incidence of premature delivery (OR 0.84, 95% CI 0.73–0.96, p = 0.01, I2 44.81%) in pregnant women with autoimmune disorders. In sub-group analysis, HCQ also significantly reduced the incidence of gestational hypertension (OR 0.42, 95% CI 0.26–0.68, p = 0.001, I2 49.33%) and preterm birth (OR 0.63, 95% CI 0.48–0.82, p = 0.001, I2 27.63%) in pregnant women with lupus. The heterogeneity of the findings mentioned above was low to moderate. There were no significant differences in the risk of other outcomes, including gestational diabetes, HELLP syndrome, thrombosis, spontaneous abortion, fetal loss, small for gestational age infant (SGA), low birth weight, stillbirth, APGAR score < 7, and congenital malformation. This meta-analysis indicated that HCQ treatment could significantly decrease the incidence of preeclampsia and premature delivery in pregnant women with autoimmune disorders. In addition, HCQ could reduce the risk of gestational hypertension in pregnant lupus patients.

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The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

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Acknowledgements

We sincerely appreciate Home for Researchers editorial team (www.home-for-researchers.com) for language editing service.

Funding

This work was supported by the National Key Research and Development Program of China (No. 2021YFC2700700).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Peking University First Hospital, Peking University, Beijing, China

    Yingnan Liu, Yumei Wei & Huixia Yang

  2. Beijing Key Laboratory of Maternal-Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China

    Yumei Wei & Huixia Yang

  3. Department of Internal Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Yueyi Zhang

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Contributions

YL and HY contributed to the design of this study. YL, YW, and HY conducted the acquisition, analysis, and interpretation of data. YZ conducted the analysis underwent through R software. YL drafted the manuscript. YL, YW, YZ, and HY revised the work. All the authors approved the version to be published. All the authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Huixia Yang.

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Date: 2022/02/25. Number: CRD42022306824.

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Liu, Y., Wei, Y., Zhang, Y. et al. Hydroxychloroquine significantly decreases the risk of preeclampsia in pregnant women with autoimmune disorders: a systematic review and meta-analysis. Clin Rheumatol 42, 1223–1235 (2023). https://doi.org/10.1007/s10067-022-06496-2

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