RESEARCH - Plaquenil (hydroxychloroquine) in lupus pregnancy

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Arthritis & Rheumatism

Volume 54, Issue 11, Pages 3640-3647

Published Online: 30 Oct 2006

Hydroxychloroquine in lupus pregnancy

E. B. Clowse 1 *, ce Magder 2, Witter 3, Petri 3

1Duke University Medical Center, Durham, North Carolina

2University of land School of Medicine, Baltimore

3s Hopkins University School of Medicine, Baltimore, land

Abstract

Objective

Hydroxychloroquine (HCQ) is often needed to manage disease activity in

systemic lupus erythematosus (SLE) during pregnancy. The purpose of

this study was to examine lupus activity and pregnancy outcomes in

women with SLE treated or not treated with HCQ during pregnancy.

Methods

This was a prospective study of pregnancies in women with SLE who were

evaluated between 1987 and 2002. The pregnancies were divided into 3

groups: no HCQ exposure during pregnancy (163 pregnancies), continuous

use of HCQ during pregnancy (56 pregnancies), or cessation of HCQ

treatment either in the 3 months prior to or during the first

trimester of pregnancy (38 pregnancies). The pregnancy outcomes, fetal

outcomes, and lupus activity during pregnancy were compared among

these groups.

Results

The rates of miscarriage, stillbirth, pregnancy loss, and congenital

abnormality were not statistically different among the 3 groups. The

degree of lupus activity during pregnancy, however, was significantly

higher in women who stopped taking HCQ. These women had a higher

degree of lupus activity, as measured by the physician's estimate of

lupus activity and the SLE Disease Activity Index, as well as an

increased rate of flare, during pregnancy. More serious lupus

complications, such as proteinuria and thrombocytopenia, were not

significantly higher in women who stopped taking HCQ. Women who

continued taking HCQ were maintained on a lower average dose of

prednisone during pregnancy.

Conclusion

We recommend the continuation of HCQ treatment during pregnancy. Our

findings are consistent with prior reports of the absence of fetal

toxicity. Similar to studies of nonpregnant women, the cessation of

HCQ treatment during pregnancy increases the degree of lupus activity.

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http://www3.interscience.wiley.com/cgi-bin/fulltext/113446016/HTMLSTART

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Not an MD