Impact of hydroxychloroquine on pregnancy outcomes in systemic lupus erythematosus: A 25 years retrospective cohort study from Asia

Background Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects various organs and follows a pattern of remission and relapse. Hydroxychloroquine (HCQ), an antimalarial drug, has recently become widely used in pregnant women with SLE due to its multi-level immune anti-inflammatory mechanisms and potential endothelial protective and thromboprophylaxis properties. While several studies have evaluated the impact of HCQ on SLE activity and the occurrence of neonatal lupus, its effects on improving early delivery, preeclampsia, and intrauterine growth restriction (IUGR) remain controversial. Objective This study aims to determine the effect of HCQ on feto-maternal outcomes among pregnant women with SLE. Methodology It is a retrospective cohort study over the past 25 years at Aga Khan Hospital, Karachi. The patients were divided into two groups. HCQ group had been taking HCQ throughout pregnancy. Non-HCQ group hadn’t been using HCQ. All statistical analysis was performed using SPSS version 19.0. For all tests, p ≤ .05 was considered statistically significant. Results A total of 125 pregnant women with SLE were reviewed. The majority had conception in the remission period. There were 7 (20.6%) babies with fetal heart block in the non-HCQ group. The overall flare-up of disease was found in 68.8% (86/125), mostly in the third trimester. Positive anticardiolipin IgG antibodies were considerably higher in HCQ groups (47.25% vs 26.47%; p = .036). Conclusion Our study findings suggest that maintaining disease remission prior to conception and continuing HCQ therapy during pregnancy may be associated with improved maternal and fetal outcomes, though the observed association with fetal heart block warrants cautious interpretation due to small numbers.