Background/Purpose: Heparins and/or low-dose aspirin represent the treatment of choice for the management of pregnant women with antiphospholipid antibodies (aPL). However, despite these treatments, maternal, fetal, and neonatal adverse outcomes related to the presence of aPL may still occur. In this study we aimed to assess the pregnancy outcome in women with aPL without other underlying connective tissue disease (CTD) who were treated with hydroxychloroquine (HCQ) in addition to conventional treatment during pregnancy.

Methods: Eighty-nine pregnancies in 48 women with persistent aPL were included in this observational, retrospective, cohort study: -Group 1: 17 pregnancies that occurred in 13 women were treated with HCQ for at least 6 months before pregnancy, and the therapy continued throughout gestation; -Group 2: 72 pregnancies that occurred in 35 women with aPL that were not treated with HCQ were included as controls. All the patients were tested positive for aPL in the absence of conclusive clinical signs/symptoms of CTD.

Results:  HCQ-treatment was associated with a higher rate of live births (82% group A vs 58% group B; p = .05). Placenta-mediated complications (pre-eclampsia and abruption placentae) were not observed in group 1 but occurred in 5 cases of group 2. Pregnancy duration was longer in group 1 than group 2 (36.4 [6-40] vs 33.5 [6-40] weeks; p = .04).

Conclusion:  Despite the limit of the small sample size, our observations support that HCQ may improve pregnancy outcome in women with aPL. A prospective randomised controlled trial of HYdroxychoroquine versus placebo during Pregnancy in women with AnTIphospholipid Antibodies (HYPATIA) also including women witn aPL without other underlying CTD is about to start recruiting.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/role-of-hydroxychloroquine-in-improving-pregnancy-outcomes-in-women-with-antiphospholipid-antibodies-without-other-underlying-connective-tissue-disease/