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Survey of antimalarial use in lupus pregnancy and lactation
Adeeba Al-Herz1, Michael Schulzer, John M Esdaile
1Arthritis Research Centre of Canada and Department of Medicine, University of British Columbia, Vancouver.
Objective:
To obtain the experience of selected experts in the use of antimalarial drugs (AM) in pregnancy and lactation in systemic lupus erythematosus.
Methods:
Seventy-eight lupus experts identified from North America and UK were mailed a 19 question survey regarding their experience using AM in pregnancy and lactation.
Results:
The 52 (67%) respondents with usable questionnaires treated a median of 75 lupus patients/year, including 4-5 lupus pregnancies/year. Thirty-five (69%) continued AM sometimes, often, or always during pregnancy. Continuing AM increased with the number of pregnant lupus patients seen (p < 0.01). None reported having seen any fetal toxicity with AM use, and pregnancy was never terminated because of AM, other than at patient insistence (n = 1). Postpartum, 29 (63%) continued AM and advised breast-feeding. Responses were consistent among North American and UK experts.
Conclusion:
The majority of lupus experts continue AM during pregnancy. This was particularly true for those who treated a larger number of pregnant lupus patients per year. The majority advise breast-feeding and continue AM postpartum. These practices are supported by the limited literature available.