Background The use of the hydroxychloroquine(HCQ) in pregnancy is controversial. The current practice of discontinuing these medications because of pregnancy makes little sense as the half-life of these medications is so long. Patients with autoimmune diseases, especially with systemic lupus erythematosus (SLE) have increased fetal wastage and one of the factors known to contribute to this fetal wastage is disease activity. It is also known that discontinuing the HCQ can precipitate flares of disease in lupus patients. Mothers and their potential offspring are therefore at risk for flares of disease and pregnancy failure if these medications are discontinued because of pregnancy.
Objectives To determine the safety for both mother and fetus of HCQ, in pregnant patients with SLE and rheumatoid arthritis (RA) who continued antimalarial drugs throughout pregnancy.
Methods We studied 30 case histories of pregnant women (22 with SLE, and 8 - with RA), all of whom took hydroxychloroquine (Plaquenil) throughout pregnancy. All 30 pregnancies, resulted in 30 live births (18 full term and 12 preterm).
Results No congenital abnormalities occurred and mean follow-up of 1 year (range 10-48 months) revealed no abnormalities in these children. Temporary discontinuation of HCQ for 1-2 months in 9 pregnancies precipitated a flare of disease (SLE or RA), documented both clinically and serologically, which required administration of glucocorticoids in relatively high doses.
Conclusions It is safer to continue hydroxychloroquine rather than to discontinue this drug simply because of pregnancy.
References Mok CC, Wong RW. Pregnancy in systemic lupus erythematosus. Postgrad Med J. 2001 Mar;77(905):157-65.
Disclosure of Interest None Declared
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