ANTIMALARIAL-DRUGS IN PREGNANCY - THE NORTH-AMERICAN EXPERIENCE

The use of the 4-aminoquinoline antimalarials in pregnancy is controve rsial. The current practice of discontinuing these medications because of pregnancy makes little sense as the half-life of these medications is so long. Patients with SLE have increased fetal wastage and one of the factors known to contribute to this fetal wastage is disease acti vity. It is also known that discontinuing the 4-aminoquinoline antimal arial drugs can precipitate flares of disease in lupus patients. Mothe rs and their potential offspring are therefore at risk for flares of d isease and pregnancy failure if these medications are discontinued bec ause of pregnancy. This review addresses the North American experience of the use of antimalarial drugs in pregnant lupus patients. Unlike m ost centers in North America, we continue our patients on these medica tions throughout pregnancy and to date have documented 16 lupus patien ts who have taken these drugs throughout pregnancy. Our most recent st udy documents nine pregnancies in eight women. All of these pregnancie s resulted in live births (five pre-term deliveries and four full-term deliveries). There were no congenital abnormalities in these infants and follow-up to date has revealed no evidence of ocular or oral defic its in any of these children. One patient experienced a flare of disea se when her antimalarial therapy was temporarily discontinued.