Efﬁcacy of Hydroxychloroquine use on placental mediated diseases in Pregnancies with Lupus and/or Antiphospholipid Autoimmunity: A Systematic Review and Meta-Analysis

Helmy, Nadia M; Al-husseiny, Maha; Abdelwahed, Reham; Dabian, Bassiony; Abdelgalil, Mostafa

doi:10.21608/egyfs.2025.457893

Efﬁcacy of Hydroxychloroquine use on placental mediated diseases in Pregnancies with Lupus and/or Antiphospholipid Autoimmunity: A Systematic Review and Meta-Analysis

Document Type : Original Article

Authors

¹ Lecturer at the Obstetrics and Gynecology department, Faculty of Medicine, Cairo University

² Department of Obstetrics & Gynecology, Cairo University's faculty of medicine

10.21608/egyfs.2025.457893

Abstract

Background: Although hydroxychloroquine (HCQ) has been utilized for the therapy of antiphospholipid syn-drome (APS) and systemic lupus erythematosus (SLE), it is unknown how HCQ affects lupus activation through-out gestation, preeclampsia, and fetal growth restriction (FGR).
Methods: Until September 11, 2024, the databases of PubMed, Embase, and Cochrane were scanned for ob-servational research or randomized clinical trials (RCTs) including extra HCQ therapy and pregnant patients with APS/positive antiphospholipid antibodies (aPLs) and/or SLE. Preeclampsia, IUGR, and high lupus activity risks were investigated.
Results: Thirteen cohort studies and one RCT were se-lected. The pooled meta-analysis comprised 1764 preg-nancies (709 in the HCQ group vs. 1055 in the placebo group). The likelihood of elevated lupus activity dropped following the extra utilization of HCQ (RR: 0.74, 95% CI: 0.57–0.97, p = 0.03). The overall prevalence of pre-eclampsia dropped (RR: 0.54, 95% CI: 0.37–0.78, p = 0.001). The SLE subgroup (RR: 0.51, 95% CI: 0.34–0.78, p = 0.002) and the APS/aPLs subgroup (RR: 0.66, 95% CI: 0.29–1.54, p = 0.34) did not exhibit statistical signiﬁcance, according to the subgroup evaluation. Nei-ther the SLE subgroup (RR: 0.74, 95% CI: 0.40–1.36, p = 0.33) nor the APS/aPLs subgroup (RR: 1.26, 95% CI: 0.34–4.61, p = 0.73) showed a statistically signiﬁcant re-duction in the prevalence for IUGR (RR: 0.80, 95% CI: 0.47–1.35, p = 0.46).
Conclusion: The results refute the notion that HCQ re-duces the risk of FGR for SLE and/or APS/aPLs or the likelihood of preeclampsia for APS/aPLs participants. Nonetheless, additional administration of HCQ may re-duce the likelihood of preeclampsia in those with SLE as well as the probability of elevated lupus activity during pregnancy.

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