Ye Shenglong, Liu Yuanying, Zhao Xueqing, Ma Yue, Wang Yongqing
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
Front Med (Lausanne). 2023 Apr 24;10:1113127. doi: 10.3389/fmed.2023.1113127. eCollection 2023.
Empirical use of Hydroxychloroquine (HCQ) in patients with positive antinuclear antibody spectrum (ANAs) test result is controversial regarding its impact on improving perinatal outcomes. This study aimed to investigate the effect of HCQ on adverse pregnancy outcomes associated with placental dysfunction in ANAs-positive patients.
The study included pregnant women with positive ANAs test result from 2016 to 2020 in our center, and divided into a weakly positive and a positive group in just ANA positive patients among them. Univariate and multivariate analyses were conducted to determine the effect of HCQ on pregnancy outcomes in each subgroup. Stratified and interactive analyses were performed to assess the value of HCQ in improving pregnancy outcomes.
(i) A total of 261 cases were included, accounting for 30.60% of pregnancy complicated with autoimmune abnormalities, and 65.12% of them used HCQ during pregnancy. (ii) The application of HCQ significantly reduced the incidence of early-onset preeclampsia (1.18% vs. 12.09%, = 0.040) and small-for-gestational-age infants (10.06% vs. 25.84%, = 0.003) in the ANAs-positive population, increased birth weight (3075.87 ± 603.91 g vs. 2847.53 ± 773.73 g, = 0.025), and prolonged gestation (38.43 ± 2.31 vs. 36.34 ± 5.45 weeks, < 0.001). (iii) A total of 185 just ANA-positive patients were stratified according to titers. Among them, the rate of HCQ usage was significantly higher than that in the weakly positive group (81.03% vs. 58.27%, = 0.003). (vi) Stratified univariate analysis showed that HCQ usage in the ANA-positive group could reduce the incidence of preeclampsia (2.13% vs. 27.27%, = 0.019) and prolong gestation (38.29 ± 2.54 vs. 34.48 ± 7.68 weeks, = 0.006). In the ANA-weakly positive group, HCQ significantly reduced the incidence of preeclampsia (6.76% vs. 28.30%, = 0.002), early-onset preeclampsia (1.35% vs. 13.21%, = 0.027), and small-for-gestational-age infants (7.89% vs. 35.19%, < 0.001). Multivariate regression analysis showed that HCQ significantly reduced the incidence of preeclampsia in both groups. Intergroup interaction analysis showed no significant difference in the value of HCQ in reducing the incidence of preeclampsia between the two groups.
ANAs positivity is an important abnormal autoimmunity type in pregnancy. HCQ can be considered as a choice for improving adverse pregnancy outcomes related to placental dysfunction, such as preeclampsia, in this population.
对于抗核抗体谱（ANA）检测结果呈阳性的患者经验性使用羟氯喹（HCQ）对改善围产期结局的影响存在争议。本研究旨在调查HCQ对ANA阳性患者中与胎盘功能障碍相关的不良妊娠结局的影响。
本研究纳入了2016年至2020年在本中心ANA检测结果呈阳性的孕妇，并在其中仅ANA阳性患者中分为弱阳性和阳性组。进行单因素和多因素分析以确定HCQ对每个亚组妊娠结局的影响。进行分层和交互分析以评估HCQ在改善妊娠结局方面的价值。
（i）共纳入261例病例，占合并自身免疫异常妊娠的30.60%，其中65.12%在孕期使用了HCQ。（ii）在ANA阳性人群中，使用HCQ显著降低了早发型子痫前期的发生率（1.18%对12.09%，P = 0.040）和小于胎龄儿的发生率（10.06%对25.84%，P = 0.003），增加了出生体重（3075.87±603.91克对2847.53±773.73克，P = 0.025），并延长了孕周（38.43±2.31对36.34±5.45周，P < 0.001）。（iii）共185例仅ANA阳性患者按滴度分层。其中，HCQ的使用率显著高于弱阳性组（81.03%对58.27%，P = 0.003）。（iv）分层单因素分析显示，ANA阳性组使用HCQ可降低子痫前期的发生率（2.13%对27.27%，P = 0.019）并延长孕周（38.29±2.54对34.48±7.68周，P = 0.006）。在ANA弱阳性组中，HCQ显著降低了子痫前期的发生率（6.76%对28.30%，P = 0.002）、早发型子痫前期的发生率（1.35%对13.21%，P = 0.027）和小于胎龄儿的发生率（7.89%对35.19%，P < 0.001）。多因素回归分析显示，HCQ在两组中均显著降低了子痫前期的发生率。组间交互分析显示，两组在HCQ降低子痫前期发生率的价值方面无显著差异。
ANA阳性是妊娠中一种重要的异常自身免疫类型。HCQ可被视为改善该人群中与胎盘功能障碍相关的不良妊娠结局（如子痫前期）的一种选择。
