ArticleThe Lancet. Rheumatology2025
Exposure to hydroxychloroquine in early pregnancy and incidence of pre-eclampsia and pre-term delivery in patients with systemic lupus erythematosus in Sweden: a nationwide population-based cohort study.
Article in The Lancet. Rheumatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Structural Control of Stromal-Immune Coupling by COL24A1 Underlies Pregnancy Maintenance.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Hydroxychloroquine Exposure Intensity During Early Pregnancy and Composite Fetal Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus: A Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Irreversible electroporation vs. stereotactic body radiotherapy for solitary hepatocellular carcinoma ≤5 cm: A multicenter retrospective study.JHEP reports : innovation in hepatology · 2026Article
- Second delivery rates and recurrence of adverse pregnancy outcomes in women with systemic lupus erythematosus: a nationwide population-based cohort study.Rheumatology (Oxford, England) · 2026Article
- Hydroxychloroquine Use, Preeclampsia, and Preterm Delivery Complications in Systemic Lupus Erythematosus Pregnancies: Is There a Protective Effect?Arthritis care & research · 2026Article
- Article
- Immune profiling-informed immunomodulation associated with gestational extension in early-onset preeclampsia with monochorionic twins: a case report.Frontiers in immunology · 2026Article
- Immune microenvironment dynamics in pregnant patients with concomitant autoimmune diseases: mechanisms, challenges, and clinical significance.Military Medical Research · 2026Review
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6 authors.
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Abstract
backgroundPregnant women with systemic lupus erythematosus (SLE) have elevated risks of pre-eclampsia and pre-term delivery. Hydroxychloroquine, the mainstay treatment during pregnancy in women with SLE, is currently a promising agent for pre-eclampsia prevention. We aimed to examine associations between hydroxychloroquine use and pre-eclampsia and pre-term delivery in pregnant women with SLE.
methodsIn this nationwide population-based cohort study, we included all singleton pregnancies of women with prevalent SLE that lead to a delivery (livebirths and stillbirths) between Jan 1, 2007, and Dec 31, 2022, diagnosed in secondary or tertiary care centres in Sweden. Hydroxychloroquine exposure was defined as two or more dispensations from 3 months pre-pregnancy until the end of the first trimester. The primary outcomes were pre-eclampsia (diagnosed from 20
findingsBetween Jan 1, 2007, and Dec 31, 2022, we included 959 singleton pregnancies from 685 women with prevalent SLE in Sweden. 404 (42%) of 959 pregnancies were nulliparous pregnancies (232 [57%] were unexposed and 172 [43%] were hydroxychloroquine-exposed) and 555 (58%) were parous pregnancies (333 [60%] were unexposed and 222 [40%] were hydroxychloroquine-exposed). The mean maternal age was 32 years (SD 4·7). Pre-eclampsia was recorded in 19 (11%) of 172 hydroxychloroquine-exposed pregnancies and 30 (13%) of 232 unexposed pregnancies in the nulliparous group and 12 (5%) of 222 hydroxychloroquine-exposed pregnancies and 20 (6%) of 333 unexposed pregnancies in the parous group. Pre-term delivery was recorded in 33 (19%) of 172 hydroxychloroquine-exposed pregnancies and 34 (15%) of 232 in unexposed pregnancies in the nulliparous group and 26 (12%) of 222 hydroxychloroquine-exposed pregnancies and 41 (12%) of 333 unexposed pregnancies in the parous group. The adjusted risk ratio for pre-eclampsia in SLE pregnancies with hydroxychloroquine exposure versus those without exposure was 0·49 (95% CI 0·31-0·79) overall, 0·59 (0·33-1·08) in the nulliparous group, and 0·44 (0·22-0·89) in the parous group. Associations between hydroxychloroquine and pre-term delivery were unclear in the overall (risk ratio 0·95 [95% CI 0·67-1·34]), nulliparous (1·10 [0·68-1·80]), and parous (0·75 [0·47-1·24]) groups. Stratification by antiphospholipid syndrome, renal diseases, and hypertension showed similar results.
interpretationIn this large cohort of pregnant women with SLE, hydroxychloroquine exposure in early pregnancy was associated with a lower pre-eclampsia risk. However, the association with pre-term delivery was unclear.
fundingUS National Institutes of Health and the Ingegerd Johansson Donation.
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