Antimalarial drugs, pregnancy and lactation

Disease activity has been demonstrated to be one of the major factors contributing to fetal loss in SLE patients, and discontinuation of antimalarial therapy can precipitate a flare of disease. It is therefore important to determine whether it is safe to continue antimalarial therapy throughout pregnancy. We have previously stated that we consider lupus patients and their fetuses to be at risk for disaster if antimalarial therapy is discontinued during pregnancy, and it has been our experience that lupus patients can produce normal offspring even if they are taking daily chloroquine or hydroxychloroquine. Several other reports now support our findings that it is probably safe to continue antimalarial therapy during pregnancy, although there are no large studies published. Data on the secretion of hydroxychloroquine in the breast milk of patients on steady-state hydroxychloroquine therapy are minimal, and further studies are required to determine whether these women can safely nurse their infants while taking hydroxychloroquine daily.