Risk factors in miscarriage: a review.

OBJECTIVE: To study maternal and fetal outcome of pregnancy in patients with lupus who were exposed to hydroxychloroquine (HCQ). METHODS: The case records of women (n = 33) exposed to HCQ during their pregnancies (n = 36) and of 53 control patients from a single lupus pregnancy centre were reviewed to determine lupus activity, obstetric experience, and infant outcome. RESULTS: HCQ was not apparently teratogenic. Lupus activity and obstetric outcome in the two groups were similar. CONCLUSION: HCQ continuation is probably safe during pregnancy in patients with lupus, but there is no obvious advantage in commencing treatment.

https://ard.bmj.com/content/annrheumdis/55/7/486.full.pdf

Hydroxychloroquine and lupus pregnancy: review of a series of 36 cases.

A cohort of 169 births to women who were exposed throughout pregnancy to chloroquine 300 mg base once a week for chemosuppression of malaria was studied. The birth defects in this cohort were compared with those in a control group of 454 births to women who were not exposed to chloroquine, most of whom lived in non-malarious areas. The proportion of birth defects in the exposed group was not significantly different from that in the control group. This observation must be considered within the limitations of the study, which could detect only a strong teratogenic effect. It could not exclude risks lower than a 5.7-fold increase in the incidence of birth defects when chloroquine was used. Women using chloroquine during pregnancy for chemosuppression of malaria can be reassured that it is not a strong teratogen, but if it is to be used the risk of developing malaria should be balanced against the lack of data to determine whether it carries a low teratogenic risk.

https://www.bmj.com/content/bmj/290/6480/1466.full.pdf

Safety of chloroquine in chemosuppression of malaria during pregnancy.

Chloroquine phosphate and hydroxychloroquine sulfate are substituted 4-amino quinoline compounds that differ only by a hydroxy group. Quinacrine hydrochloride also has the 4-amino quinoline radical but has, in addition, a benzene ring; it is classified as an acridine compound. The 4-amino quinoline radical is present in all antimalarial compounds shown to be effective in the treatment of lupus erythematosus (LE) (Figure).1 HISTORY Quinacrine was introduced for malaria therapy in 1930. Its superiority over quinine was established during World War II, when it became the official drug for the treatment of malaria. The toxicity of quinacrine and its inability either to cure malaria or to act as an effective prophylactic, however, spurred continued research for better drugs. A large series of 4-amino quinolines were investigated. Of these, chloroquine proved to be the most promising and was released for field trial.2By the end of World War II, it had

Birnbaum S

Papers

Malaria associated with pregnancy.