Hydroxychloroquine (Plaquenil) During Pregnancy for Lupus

What does the evidence say about hydroxychloroquine during pregnancy?

1. The Society for Maternal-Fetal Medicine recommends continuing or starting hydroxychloroquine during pregnancy for lupus. When lupus is inactive and no medicine is being used, the benefits and limitations of starting hydroxychloroquine need an individual discussion. 1
2. A real-world study of 288 pregnancies exposed to chloroquine or hydroxychloroquine found no increased risk of major congenital malformations, prematurity, or low birth weight. 2
3. In one lupus-pregnancy study, hydroxychloroquine use was linked to about 2.4 weeks longer pregnancy duration among preterm births, with no statistically significant difference in miscarriage or fetal loss between users and non-users. 3
4. A large California-based lupus cohort found no evidence that early-pregnancy hydroxychloroquine use increased preterm delivery risk, and noted that stopping the drug has been linked to flares that themselves raise preterm birth and preeclampsia risk. 4
5. Hydroxychloroquine may lower the chance of congenital heart block, a serious but rare neonatal lupus complication, in pregnancies already at elevated risk for it. 1

Is hydroxychloroquine safe in each trimester?

• First trimester. Continuing hydroxychloroquine from the start of pregnancy is what current rheumatology guidance recommends for lupus, since studies of exposed pregnancies have not found a higher rate of major congenital malformations.
• Second trimester. Hydroxychloroquine may lower the chance of congenital heart block, a rare but serious neonatal lupus complication, in pregnancies already at elevated risk for it.
• Third trimester. Studies following pregnancies through delivery have not found a higher chance of preterm birth or low birth weight with continued hydroxychloroquine use, and one study linked it to longer pregnancy duration among preterm births.