Background The antimalarial drugs decrease the risk of lupus activity during gestation, but the beneficial effect on other maternal-fetal complications is controversial.
Objectives To analyze the beneficial effect of antimalarial drugs on maternal-fetal complications in pregnant women with systemic lupus erythematosus (SLE).
Methods A prospective cohort of pregnant women with SLE (ACR 1997) from January 2009 to June 2015 was studied. The patients were assessed every 4 to 6 weeks and postpartum both, by a rheumatologist and a gynecologist. Clinical, biochemical, and immunological characteristics, along with maternal and fetal complications were registered. For analysis, the patients were allocated to one of two groups: pregnancies exposed to antimalarial drugs in comparison to those not exposed. A logistic regression analysis including variables such as smoking, obesity, infections, first pregnancy, age, SLE flare, drugs (prednisone, antimalarials, aspirin, and azathioprine), anti-DNA antibodies, anticardiolipin antibodies, and antiphospholipid syndrome was performed.
Results We studied 197 lupus pregnancies, 154 expose to antimalarial drugs and 47 unexposed. We found no differences between groups in age, years of evolution of SLE, first pregnancy, childhood-onset SLE, lupus nephritis, and use of prednisone, aspirin and azathioprine. The rate of most maternal and fetal complications was also similar in both groups (Table). A lower incidence of preeclampsia was observed in patients exposed to antimalarial drugs compared to those not exposed (9% vs 23%, p=0.01). Additionally, 2 maternal deaths in patients not exposed to antimalarial drugs. The logistic regression analysis showed that the use of antimalarial drugs during pregnancy is a protective factor for the development of preeclampsia (RR 0.1, 95% CI 0.05–0.58, p=0.004); on the other hand, active SLE before pregnancy (RR 4.8, 95% CI 1.3–17.8, p=0.01) and lupus nephritis (RR 2.9, 95% CI 0.9–8.8, p=0.05) were associated factors with the development of preeclampsia.
Conclusions Our study suggests that the use of antimalarial drugs during pregnancy can prevent the development of preeclampsia in women with SLE.
Disclosure of Interest None declared
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