ArticleRheumatology (Oxford, England)2025
Hydroxychloroquine in lupus or rheumatoid arthritis pregnancy and risk of major congenital malformations: a population-based cohort study.
Article in Rheumatology (Oxford, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 3 of them syntheses that pooled it.
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Who cites it
10 citing papers in PubMed, 3 syntheses or guidelines pooled it, 17 citations in OpenAlex.
- Maternal systemic lupus erythematosus and the risk of congenital cardiovascular abnormalities in offspring: a systematic review and meta-analysis.Immunologic research · 2026Pooled it
- The Asia Pacific League of Associations for Rheumatology (APLAR) Consensus Statements for the Management of Reproductive Issues in Autoimmune Rheumatic Diseases.International journal of rheumatic diseases · 2026Pooled it
- Hydroxychloroquine and pregnancy outcomes in patients with anti-phospholipid syndrome: a systematic review and meta-analysis.RMD open · 2025Pooled it
- Safety and clinical considerations of alopecia therapies during pregnancy, fertility treatment, and polycystic ovary syndrome workup.International journal of women's dermatology · 2026Review
- Defining Optimally Safe and Effective Blood Levels of Hydroxychloroquine in Lupus: An Important Step Toward Precision Drug Monitoring.Arthritis & rheumatology (Hoboken, N.J.) · 2026Observational
- Pregnancy planning in women with rheumatic diseases: an integrated framework for risk stratification and multidisciplinary management.Rheumatology international · 2026Review
- Hydroxychloroquine therapy for women with both recurrent pregnancy loss and autoimmune disease: association with pregnancy outcomes and maternal-fetal complications.Frontiers in immunology · 2026Article
- Risk of preterm delivery and early pregnancy hydroxychloroquine use from a Californian lupus cohort.Lupus science & medicine · 2025Article
- Rheumatoid Arthritis and Pregnancy: Managing Disease Activity and Fertility Concerns.Seminars in reproductive medicine · 2024Review
- Risk Assessment and Optimization for Pregnancy in Patients with Rheumatic Diseases.Diagnostics (Basel, Switzerland) · 2024Review
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
Abstract
objectivesTo assess the infant risk of major congenital malformations (MCM) associated with first-trimester exposure to hydroxychloroquine (HCQ) among mothers with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA).
methodsThis population-based cohort study utilized Swedish nationwide registers and included all singleton births (2006-2021) among individuals with prevalent SLE or RA in Sweden. The exposure was filling ≥1 HCQ prescription during the first trimester. The outcome was infant MCM within 1 year of birth. Inverse probability of treatment weighting was applied to adjust for potential confounders (e.g. maternal smoking, body mass index, pregestational diabetes and corticosteroids). Modified Poisson regression models with robust variance were used to estimate risk ratios (RR) and 95% CI.
resultsWe included 1007 births (453 exposed) and 2500 births (144 exposed) in the SLE and RA cohorts, respectively. The MCM risks in the SLE overall cohort, exposed and unexposed groups were 3.6%, 3.7% and 3.4%, respectively. The corresponding figures in the RA cohort were 4.4%, 5.6% and 4.3%, respectively. The adjusted RRs (95% CI) were 1.29 (0.65, 2.56) in the SLE cohort, 1.32 (0.56, 3.13) in the RA cohort and 1.30 (0.76, 2.23) in the pooled analysis. The adjusted risk difference (exposed vs unexposed) was small (0.9% in SLE and 1.3% in RA). Sensitivity analyses examining different exposure and outcome windows yielded similar findings.
conclusionFirst-trimester exposure to HCQ was not associated with a significantly increased risk of MCM. HCQ's benefits may outweigh the risks in managing SLE or RA during pregnancy.
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