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Rector A, Marić I, Chaichian Y, Chakravarty E, Cantu M, Weisman MH, Shaw GM, Druzin M, Simard JF. Hydroxychloroquine in Lupus Pregnancy and Risk of Preeclampsia. Arthritis Rheumatol 2024; 76:919-927. [PMID: 38272838 PMCID: PMC11136600 DOI: 10.1002/art.42793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 11/28/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) disproportionately affects women during childbearing years, and hydroxychloroquine (HCQ) is the standard first-line treatment. Preeclampsia complicates up to one-third of pregnancies in lupus patients, although reports vary by parity and multifetal gestation. We investigated whether taking HCQ early in pregnancy may reduce the risk of preeclampsia. METHODS We studied 1,068 live birth singleton pregnancies among 1,020 privately insured patients with SLE (2007-2016). HCQ treatment was defined as three months preconception through the first trimester, and prescription fills were a proxy for taking HCQ. Modified Poisson regression estimated risk ratios (RRs) and 95% confidence intervals (CIs), stratified by parity. Propensity scores accounted for confounders, and stratified analyses examined effect modification. RESULTS Approximately 15% of pregnant patients were diagnosed with preeclampsia. In 52% of pregnancies, patients had one or more HCQ fills. Pregnant patients exposed to HCQ had more comorbidities, SLE activity, and azathioprine treatment. We found no evidence of a statistical association between HCQ and preeclampsia among nulliparous (RR 1.26 [95% CI 0.82-1.93]) and multiparous pregnancies (RR 1.20 [95% CI 0.80-1.70]). Additional controls for confounding decreased the RRs toward the null (nulliparous pregnancy, propensity score-adjusted [PS-adj] RR 1.09 [95% CI 0.68-1.76]; multiparous pregnancy, PS-adj RR 1.01 [95% CI 0.66-1.53]). CONCLUSION Using a large insurance-based database, we did not observe a decreased risk of preeclampsia associated with HCQ treatment in pregnancy, although we cannot rule out residual and unmeasured confounding and misclassification. Further studies leveraging large population-based data and prospective collection could characterize how HCQ influences preeclampsia risk in pregnant patients with SLE and among persons at greater risk of hypertensive disorders of pregnancy.
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Affiliation(s)
- Amadeia Rector
- Department of Epidemiology and Population Health, Stanford University School of Medicine
| | - Ivana Marić
- Department of Pediatrics, Stanford University School of Medicine
| | - Yashaar Chaichian
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine
| | - Eliza Chakravarty
- Arthritis and Clinical Immunology. Oklahoma Medical Research Foundation, Oklahoma City, OK 73104
| | | | - Michael H Weisman
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine
| | - Maurice Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine
| | - Julia F Simard
- Department of Epidemiology and Population Health, Stanford University School of Medicine
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine
- Department of Obstetrics and Gynecology, Stanford University School of Medicine
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Gajić M, Schröder-Heurich B, Mayer-Pickel K. Deciphering the immunological interactions: targeting preeclampsia with Hydroxychloroquine's biological mechanisms. Front Pharmacol 2024; 15:1298928. [PMID: 38375029 PMCID: PMC10875033 DOI: 10.3389/fphar.2024.1298928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
Preeclampsia (PE) is a complex pregnancy-related disorder characterized by hypertension, followed by organ dysfunction and uteroplacental abnormalities. It remains a major cause of maternal and neonatal morbidity and mortality worldwide. Although the pathophysiology of PE has not been fully elucidated, a two-stage model has been proposed. In this model, a poorly perfused placenta releases various factors into the maternal circulation during the first stage, including pro-inflammatory cytokines, anti-angiogenic factors, and damage-associated molecular patterns into the maternal circulation. In the second stage, these factors lead to a systemic vascular dysfunction with consecutive clinical maternal and/or fetal manifestations. Despite advances in feto-maternal management, effective prophylactic and therapeutic options for PE are still lacking. Since termination of pregnancy is the only curative therapy, regardless of gestational age, new treatment/prophylactic options are urgently needed. Hydroxychloroquine (HCQ) is mainly used to treat malaria as well as certain autoimmune conditions such as systemic lupus and rheumatoid arthritis. The exact mechanism of action of HCQ is not fully understood, but several mechanisms of action have been proposed based on its pharmacological properties. Interestingly, many of them might counteract the proposed processes involved in the development of PE. Therefore, based on a literature review, we aimed to investigate the interrelated biological processes of HCQ and PE and to identify potential molecular targets in these processes.
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Affiliation(s)
- Maja Gajić
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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Mayer-Pickel K, Nanda M, Gajic M, Cervar-Zivkovic M. Preeclampsia and the Antiphospholipid Syndrome. Biomedicines 2023; 11:2298. [PMID: 37626793 PMCID: PMC10452741 DOI: 10.3390/biomedicines11082298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Antiphospholipid syndrome (APS) is characterized by venous or arterial thrombosis and/or adverse pregnancy outcome in the presence of persistent laboratory evidence of antiphospholipid antibodies (aPLs). Preeclampsia complicates about 10-17% of pregnancies with APS. However, only early onset preeclampsia (<34 weeks of gestation) belongs to the clinical criteria of APS. The similarities in the pathophysiology of early onset preeclampsia and APS emphasize an association of these two syndromes. Overall, both are the result of a defective trophoblast invasion and decidual transformation at early gestation. Women with APS are at increased risk for prematurity; the reasons are mostly iatrogenic due to placental dysfunction, such as preeclampsia or FGR. Interestingly, women with APS have also an increased risk for preterm delivery, even in the absence of FGR and preeclampsia, and therefore it is not indicated but spontaneous. The basic treatment of APS in pregnancy is low-dose aspirin and low-molecular-weight heparin. Nevertheless, up to 20-30% of women develop complications at early and late gestation, despite basic treatment. Several additional treatment options have been proposed, with hydroxychloroquine (HCQ) being one of the most efficient. Additionally, nutritional interventions, such as intake of vitamin D, have shown promising beneficial effects. Curcumin, due to its antioxidant and anti-inflammatory properties, might be considered as an additional intervention as well.
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Affiliation(s)
- Karoline Mayer-Pickel
- Department of Obstetrics, Medical University Graz, 8036 Graz, Austria; (M.N.); (M.G.); (M.C.-Z.)
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Xu S, Liu M, Xu J, Che B, Zhang W, Li W, Huang T, Yu Y, Zha C, Peng Z, Huang K, Tang K. Pregnancy complicated with adrenal adenoma causing ACTH-independent Cushing's syndrome, accompanied by obstetric antiphospholipid syndrome and severe pre-eclampsia: case report and literature review. Front Endocrinol (Lausanne) 2023; 14:1147316. [PMID: 37274343 PMCID: PMC10235702 DOI: 10.3389/fendo.2023.1147316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
This case report shares the management experience of a patient with pregnancy combined with adrenal adenoma causing ACTH-independent Cushing's syndrome (CS), accompanied by obstetric antiphospholipid syndrome (OAPS) and severe pre-eclampsia. The case was a 26-year-old that presented with typical clinical symptoms and signs of CS. The patient had a history of 4 spontaneous abortions in the last 4 years. The 24-hour urinary free cortisol was significantly increased, an abnormal cortisol circadian rhythm was demonstrated by a high late-night salivary cortisol, blood ACTH was suppressed (< 1ng/dL), anticardiolipin antibody was positive, and imaging examination showed an adrenal tumor. The patient underwent laparoscopic adrenal tumor resection under general anesthesia at 23 weeks of gestation. The tumor was pathologically confirmed to be an adrenocortical adenoma. The patient underwent a cesarean section at 39 weeks of gestation to give birth to a healthy baby girl with an Apgar score of 10. Pregnancy complicated by CS is clinically rare, easily masked by normal physiological changes of pregnancy, and is difficult to diagnose. The determination of 24-hour urinary free cortisol, the circadian rhythm of serum cortisol, ultrasound, and MRI can be helpful in the diagnosis of CS during pregnancy. Surgery is the first choice for the treatment of CS during pregnancy. As a subtype of antiphospholipid syndrome, patients with OAPS are prone to thrombotic events and recurrent miscarriages if not treated accordingly. To our knowledge no cases of CS with OAPS and severe pre-eclampsia have been reported. We summarize the experience of the treatment of this patient and review the literature to improve clinicians' awareness of this disease.
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Affiliation(s)
- Shenghan Xu
- Department of Urology and Andrology, the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Miao Liu
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Jiamu Xu
- The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bangwei Che
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Wenjun Zhang
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Wei Li
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Tao Huang
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Ying Yu
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Cheng Zha
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Zheng Peng
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Kunyuan Huang
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Kaifa Tang
- Department of Urology and Andrology, the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, China
- The Clinical Medical College of Guizhou Medical University, Guiyang, China
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Liu Y, Wei Y, Zhang Y, Yang H. Hydroxychloroquine significantly decreases the risk of preeclampsia in pregnant women with autoimmune disorders: a systematic review and meta-analysis. Clin Rheumatol 2023; 42:1223-1235. [PMID: 36729357 DOI: 10.1007/s10067-022-06496-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 02/03/2023]
Abstract
This meta-analysis aimed to investigate whether hydroxychloroquine (HCQ) intervention could decrease the incidence of preeclampsia and other maternal and fetal outcomes among pregnant women with autoimmune disorders. PubMed, EMBASE, Web of Science, and the Cochrane databases were searched from inception until January 2022. Data on maternal or fetal outcomes of the control and hydroxychloroquine treatment groups were gathered and analyzed. Pooled odds ratio (OR) with 95% confidence intervals (CIs) were determined. Cochran's Q test, I2 statistics, leave-one-out analysis, Baujat plot analysis, GOSH plot analysis, and multivariable meta-regression were applied to assess between-study heterogeneity. The meta-analysis was performed using the Stata V.16.1 software. Baujat plot analysis and GOSH plot analysis were performed using the R V.4.0.0 software. Our study included 21 cohort studies and one case-control study with a total of 3948 pregnancies with immune disorders. HCQ treatment significantly reduced the incidence of preeclampsia (OR 0.45, 95% CI 0.33-0.63, p = 0.000, I2 3.68%). After outlier omission, HCQ treatment significantly reduced the incidence of premature delivery (OR 0.84, 95% CI 0.73-0.96, p = 0.01, I2 44.81%) in pregnant women with autoimmune disorders. In sub-group analysis, HCQ also significantly reduced the incidence of gestational hypertension (OR 0.42, 95% CI 0.26-0.68, p = 0.001, I2 49.33%) and preterm birth (OR 0.63, 95% CI 0.48-0.82, p = 0.001, I2 27.63%) in pregnant women with lupus. The heterogeneity of the findings mentioned above was low to moderate. There were no significant differences in the risk of other outcomes, including gestational diabetes, HELLP syndrome, thrombosis, spontaneous abortion, fetal loss, small for gestational age infant (SGA), low birth weight, stillbirth, APGAR score < 7, and congenital malformation. This meta-analysis indicated that HCQ treatment could significantly decrease the incidence of preeclampsia and premature delivery in pregnant women with autoimmune disorders. In addition, HCQ could reduce the risk of gestational hypertension in pregnant lupus patients.
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Affiliation(s)
- Yingnan Liu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Peking University, Beijing, China
| | - Yumei Wei
- Department of Obstetrics and Gynecology, Peking University First Hospital, Peking University, Beijing, China
- Beijing Key Laboratory of Maternal-Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
| | - Yueyi Zhang
- Department of Internal Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Peking University, Beijing, China.
- Beijing Key Laboratory of Maternal-Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China.
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Fernández-Buhigas I. Obstetric management of the most common autoimmune diseases: A narrative review. Front Glob Womens Health 2022; 3:1031190. [PMID: 36505012 PMCID: PMC9728613 DOI: 10.3389/fgwh.2022.1031190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Historically, women with an autoimmune disease (AD) could not get pregnant due to infertility frequently linked to the medical condition or because the pregnancy was contraindicated, as it could harm the mother and the future child. Sometimes, pregnancy was contraindicated because the medication needed to control the AD could not be given during pregnancy. All these items are no longer true nowadays. Fertility treatments have advanced, obstetric care is better, and the medical treatments of autoimmune diseases have progressed, so women with any kind of AD are encouraged to get pregnant, and their presence in obstetric clinics is arising. This is challenging for the obstetricians, as to be sure that these pregnancies are safe for the mother and the future child, the obstetricians need to know the natural evolution of these conditions, the impact of pregnancy and postpartum on the illness, and the impact of the AD in the pregnancy. In this narrative review, we aim to make a brief resume of the obstetric management of the most common diseases (Systemic lupus erythematosus, antiphospholipid syndrome, the Anti-Ro/SSA and Anti-La/SSB antigen-antibody systems, rheumatoid arthritis, Sjögren's syndrome and Undifferentiated systemic rheumatic disease and overlap syndromes).
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Affiliation(s)
- Irene Fernández-Buhigas
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Madrid, Spain,School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain,Correspondence: Irene Fernández-Buhigas
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7
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Gerde M, Ibarra E, Mac Kenzie R, Fernandez Suarez C, Heer C, Alvarez R, Iglesias M, Balparda J, Beruti E, Rubinstein F. The impact of hydroxychloroquine on obstetric outcomes in refractory obstetric antiphospholipid syndrome. Thromb Res 2021; 206:104-110. [PMID: 34454240 DOI: 10.1016/j.thromres.2021.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of low-dose aspirin (LDA) and heparin has improved pregnancy outcomes in women with antiphospholipid syndrome (APS). However, 20-30% still have adverse outcomes despite treatment. Recent retrospective studies showed a beneficial effect of hydroxychloroquine (HCQ) in APS due to its anti-inflammatory, immunomodulatory and antithrombotic properties. Data in refractory obstetric APS (OAPS) remain scarce and include heterogeneous populations with various concomitant treatments. OBJECTIVE The objective of this study was to assess the impact on the obstetric outcomes of adding HCQ to classical treatments for women with refractory primary obstetric APS. METHODS In a retrospective single-centre cohort study, we compared pregnancy outcomes in women with refractory primary OAPS (2004-2019) who received two different treatments in subsequent pregnancies. Group A received 400 mg HCQ + 60 mg enoxaparin + LDA, while Group B received 60 mg enoxaparin + LDA. The main outcome was live birth rates, while pregnancy complications (early and late pregnancy losses and placental-mediated complications) were the secondary outcome. RESULTS A total of 101 pregnancies in 87 refractory primary OAPS patients were included. The rate of live-born babies in Group A (HCQ) was 97.1% (67/69) vs. 62.5% (20/32) in Group B (RR: 1.55 [95% CI, 1.19-2.1]; p < 0.001). Pregnancy complications in Group A were 8.7% (6/69) vs. 37.5% (12/32) in Group B (RR 0.22 [95% CI, 0.15-0.30]; p < 0.001). CONCLUSION Hydroxychloroquine was associated with a higher rate of live births and a lower prevalence of pregnancy complications in refractory primary obstetric APS. The addition of HCQ to classical treatment may present a promising approach that needs to be confirmed with prospective studies.
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Affiliation(s)
- M Gerde
- Department of Obstetrics and Gynecology, Hospital Universitario Austral, Av., Juan Domingo Perón 1500, Pilar Centro, Provincia de Buenos Aires, Argentina.
| | - E Ibarra
- Department of Obstetrics and Gynecology, Hospital Universitario Austral, Av., Juan Domingo Perón 1500, Pilar Centro, Provincia de Buenos Aires, Argentina
| | - R Mac Kenzie
- Division of Vascular Surgery and Phlebology, FLENI, Montañeses 2325, Ciudad de Buenos Aires, Argentina
| | - C Fernandez Suarez
- Department of Obstetrics and Gynecology, Hospital Universitario Austral, Av., Juan Domingo Perón 1500, Pilar Centro, Provincia de Buenos Aires, Argentina
| | - C Heer
- Department of Obstetrics and Gynecology, Hospital Universitario Austral, Av., Juan Domingo Perón 1500, Pilar Centro, Provincia de Buenos Aires, Argentina
| | - R Alvarez
- Department of Obstetrics and Gynecology, Hospital Universitario Austral, Av., Juan Domingo Perón 1500, Pilar Centro, Provincia de Buenos Aires, Argentina
| | - M Iglesias
- Department of Obstetrics and Gynecology, Hospital Universitario Austral, Av., Juan Domingo Perón 1500, Pilar Centro, Provincia de Buenos Aires, Argentina
| | - J Balparda
- Department of Obstetrics and Gynecology, Hospital Universitario Austral, Av., Juan Domingo Perón 1500, Pilar Centro, Provincia de Buenos Aires, Argentina.
| | - E Beruti
- Department of Obstetrics and Gynecology, Hospital Universitario Austral, Av., Juan Domingo Perón 1500, Pilar Centro, Provincia de Buenos Aires, Argentina.
| | - F Rubinstein
- Departamento de Educación, Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024, Ciudad de Buenos Aires, Argentina
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Pleguezuelo DE, Cabrera-Marante O, Abad M, Rodriguez-Frias EA, Naranjo L, Vazquez A, Villar O, Gil-Etayo FJ, Serrano M, Perez-Rivilla A, de la Fuente-Bitaine L, Serrano A. Anti-Phosphatidylserine/Prothrombin Antibodies in Healthy Women with Unexplained Recurrent Pregnancy Loss. J Clin Med 2021; 10:jcm10102094. [PMID: 34068095 PMCID: PMC8152729 DOI: 10.3390/jcm10102094] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/21/2021] [Accepted: 05/10/2021] [Indexed: 12/17/2022] Open
Abstract
Recurrent pregnancy loss (RPL) affects up to 6% of couples. Although chromosomal aberrations of the embryos are considered the leading cause, 50% of cases remain unexplained. Antiphospholipid Syndrome is a known cause in a few cases. Antiphospholipid antibodies (aPL) anticardiolipin, anti-Beta-2-Glycoprotein-I and Lupus Anticoagulant (criteria aPL) are recommended studies in RPL workup. We tested healthy women with unexplained RPL for criteria aPL and anti-Phosphatidylserine/Prothrombin antibodies (aPS/PT). Patients were classified into three groups according to the number and pregnancy week of RPL: Extra-Criteria (EC), with 2 miscarriages, Early Miscarriage (EM), with ≥3 before pregnancy at week 10 and Fetal Loss (FL), with ≥1 fetal death from pregnancy at week 10. Circulating criteria aPL were absent in 98.1% of EM, 90.9% of FL and 96.6% of EC groups. In contrast, aPS/PT were positive in 15.4% of EM, 15.1% of FL, 16.6% of EC patients and 2.9% in controls. aPS/PT posed a risk for RPL, with an odds ratio of 5.96 (95% confidence interval (CI): 1.85-19.13. p = 0.002) for EM, 7.28 (95% CI: 2.07-25.56. p = 0.002) for FL and 6.56. (95% CI: 1.77-24.29. p = 0.004) for EC. A successful live birth was achieved in all pregnant patients positive for aPS/PT who received treatment with heparin, aspirin and/or hydroxychloroquine.
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Affiliation(s)
- Daniel E. Pleguezuelo
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
- Correspondence: ; Tel.: +34-917792756
| | - Oscar Cabrera-Marante
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Magdalena Abad
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Edgard Alfonso Rodriguez-Frias
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Laura Naranjo
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Alicia Vazquez
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Olga Villar
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Francisco Javier Gil-Etayo
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
| | - Manuel Serrano
- Healthcare Research Institute, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Alfredo Perez-Rivilla
- Department of Microbiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Laura de la Fuente-Bitaine
- Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (M.A.); (A.V.); (O.V.); (L.d.l.F.-B.)
| | - Antonio Serrano
- Department of Immunology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; (O.C.-M.); (E.A.R.-F.); (L.N.); (F.J.G.-E.); (A.S.)
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Larosa M, Le Guern V, Morel N, Belhocine M, Ruffatti A, Silva NM, Paule R, Mouthon L, Dreyfus M, Piette JC, Souchaud-Debouverie O, Deneux-Tharaux C, Guettrot-Imbert G, Tsatsaris V, Pannier-Metzger E, Murarasu A, Doria A, Costedoat-Chalumeau N. Evaluation of the severe preeclampsia classification criterion for antiphospholipid syndrome in a study of 40 patients. Arthritis Res Ther 2021; 23:134. [PMID: 33947469 PMCID: PMC8094564 DOI: 10.1186/s13075-021-02518-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background The criteria for antiphospholipid syndrome (APS) include severe preeclampsia and/or placental insufficiency leading to preterm delivery before 34 weeks of gestation, but this APS manifestation has been rarely studied. Thus, we report a series of severe preeclampsia occurred in patients with APS. Methods We retrospectively analysed data of women with APS (Sydney criteria) who experienced severe preeclampsia with delivery before 34 weeks’ gestation between 2000 and 2017 at five French internal medicine departments and one Italian rheumatology unit. Results The 40 women had a mean age of 30.5 ± 4.6 years at their first episode of preeclampsia; 21 were nulligravid (52.5%), 12 (30%) had already been diagnosed with APS, and 21 (52.5%) had a triple-positive antiphospholipid (aPL) antibody test. Preeclampsia occurred at a median gestational age of 25.5 weeks (IQR 23-29). It was associated with HELLP in 18 cases (45%), eclampsia in 6 (15%), placental abruption in 3 (7.5%), catastrophic APS in 3 (7.5%), and foetal and neonatal death in 11 and 15 cases. Overall, 14 (35%) children survived, born at a median gestational age of 31 weeks. Among other APS criteria, 16 women (40%) experienced at least one thrombosis, 17 (42.5%) an intrauterine foetal death, and 19 (47.5%) at least one episode of HELLP during follow-up (median 5 years, IQR = 2-8). None had three or more consecutive miscarriages. Notably, 12 women (30%) had systemic lupus erythematosus. Conclusions Severe preeclampsia led to high mortality in the offspring. Almost half of these women experienced other APS features, but not three consecutive miscarriages. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02518-7.
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Affiliation(s)
- Maddalena Larosa
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France.,Division of Rheumatology, Department of Medicine-DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Mériem Belhocine
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France.,Sacré-Coeur Hospital, Internal Medicine Department, University of Montréal, Montréal, Canada
| | - Amelia Ruffatti
- Division of Rheumatology, Department of Medicine-DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Nicolas Martin Silva
- University Hospital Center of Caen, Department of Internal Medicine, Caen, France
| | - Romain Paule
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Luc Mouthon
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France.,Université de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Michel Dreyfus
- University Hospital Center of Caen, Gynecology and Obstetrics Department, Caen, France
| | - Jean-Charles Piette
- AP-HP, Pitié-Salpétrière University Hospital, Internal Medicine and Clinical Immunology Department, Centre de référence maladies auto-immunes et systémiques rares de l'Ile de France, Paris, France
| | | | - Catherine Deneux-Tharaux
- INSERM U 1153, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Université de Paris, Paris, France
| | - Gaelle Guettrot-Imbert
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Vassilis Tsatsaris
- AP-HP, Cochin Broca Hôtel-Dieu Hospital, Port-Royal maternity, DHU Risk in Pregnancy, INSERM Unité 1139, Paris, France
| | - Emmanuelle Pannier-Metzger
- AP-HP, Cochin Broca Hôtel-Dieu Hospital, Port-Royal maternity, DHU Risk in Pregnancy, INSERM Unité 1139, Paris, France
| | - Anne Murarasu
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine-DIMED, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Paris, France. .,Université de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France. .,INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France.
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