(776) Maternal-Perinatal Outcomes in Pregnancies Exposed to Hydroxyurea

Hydroxyurea (HU) is an oral chemotherapeutic agent. Despite therapeutic efficacy, it is not recommended during pregnancy due to concerns of potential teratogenicity. Our objective was to assess maternal-perinatal outcomes among patients exposed to HU during pregnancy.

Study Design:

A systematic literature review using PubMed, Scopus, CINAHL, Clinicaltrials.gov and the Cochrane library was performed from inception through January 2023. This systematic review was performed according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) statement and the protocol was registered with PROSPERO (CRD42020203416). All studies that reported outcomes in pregnancy exposed to HU, including case reports and case series, were included. Exclusion criteria included patient self-reported outcomes. Pregnancy outcomes were live birth, early pregnancy loss (< 20 weeks), stillbirth, infant death, or termination of pregnancy (TOP). Perinatal outcomes were presence of congenital anomaly, fetal growth restriction (FGR), and preterm birth (PTB).

Results:

A total of 225 pregnancies exposed to HU across 35 publications were included. HU indications were sickle cell disease 142 (61.3%), chronic myeloid leukemia 35 (15.6%), essential thrombocytopenia 28 (12.4%), and other conditions 15 (6.7%). First trimester exposure was documented in 195 (86.7%). Among continuing pregnancies (n=185), outcomes included live birth (84.3%), early pregnancy loss (13.5%), stillbirth (2.2%), and infant death (0.5%) (Table 1). Among continuing pregnancies at > 20 weeks (n=160), perinatal outcomes included FGR 7 (4.4%), PTB 22 (13.8%) and congenital anomaly 3 (1.9%) including pilonidal cyst, unilateral renal dilatation, and hip dysplasia. Of these 160 pregnancies, 125 (78.1%) had no reported adverse perinatal outcomes.

Conclusion:

Pregnant patients should be counseled that exposure to HU does not appear to increase the risk of early pregnancy loss nor congenital malformation. Additionally, the rate of stillbirths, FGR and PTB appear favorable in the context of high-risk pregnancy with sickle cell disease or malignancy.