Abstract
OBJECTIVE: We aimed to assess the effectiveness of hydroxychloroquine (HCQ) in preventing hypertensive pregnancy disorders (HPD) among women with recurrent spontaneous abortion (RSA). STUDY DESIGN: This retrospective cohort study included 462 pregnant women with RSA. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to balance baseline characteristics between HCQ and non-HCQ groups. The primary outcome comprised a composite of HPD, including preeclampsia, eclampsia, and gestational hypertension. Secondary outcomes included maternal complications and neonatal outcomes. RESULTS: HCQ was associated with a 62% decreased risk of HPD compared to no HCQ (weighted hazard ratio 0.38, 95% CI 0.16-0.94, P < 0.001). The cumulative incidence of HPD at 34 weeks was lower among HCQ users (5% vs 14%, P = 0.03). HCQ demonstrated greater efficacy in preventing HPD among women aged < 35 years, a body mass index (BMI) of ≥ 28, non-in vitro fertilization (IVF) pregnancies, and fewer than three prior miscarriages (P-interaction < 0.05). Notably, the risk of HPD was significantly lowered by 56 and 53% in combined HCQ and aspirin with/without low-molecular-weight heparin (LMWH) group compared with no HCQ counterpart, respectively. CONCLUSIONS: HCQ demonstrated promising efficacy in reducing HPD, particularly when used in conjunction with aspirin and/or LMWH therapy.