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Background <p>Hydroxychloroquine (HCQ), a 4-aminoquinoline originally developed as an antimalarial, is widely used as an immunomodulatory therapy in rheumatic diseases during pregnancy. It is recommended for women with Systemic lupus erythematosus (SLE) and Antiphospholipid syndrome (APS), with emerging interest in broader obstetric applications.</p> Objective <p>To synthesise current evidence on the pharmacology, mechanisms of action, clinical applications, and safety of HCQ in pregnancy and lactation, and to appraise its place in contemporary obstetric practice.</p> Methods <p>We conducted a structured narrative review of peer-reviewed literature indexed in PubMed, Embase, and the Cochrane Library (January 2005 to March 2026), and consultation of major international guidelines. Randomised controlled trials, cohort studies, systematic reviews, meta-analyses, mechanistic studies, and authoritative clinical guidelines were prioritised.</p> Findings <p>Current data support the safety of HCQ at doses ≤ 400&#xa0;mg/day, with no consistent increase in major congenital malformations or adverse birth outcomes. HCQ reduces disease flares in SLE pregnancies, lowers the risk of preeclampsia, and improves live-birth rates in obstetric APS. Emerging but lower-certainty evidence suggests a possible benefit in antinuclear antibody–positive recurrent pregnancy loss and recurrent implantation failure. HCQ is compatible with breastfeeding. Evidence for use in recurrent pregnancy loss and implantation failure remains limited.</p> Conclusion <p>Current evidence affirms HCQ as a safe and effective pharmacotherapy in rheumatic disease pregnancies, with potential benefits in selected obstetric indications. Ongoing randomised trials are required.</p>

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Hydroxychloroquine in pregnancy: therapeutic applications, mechanisms of action, and safety — a narrative review

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Ameena Kadar K A,
  • Hanna T S,
  • Raima Nazar,
  • Sathya M,
  • Venkateswaran R,
  • Karthikeyan V,
  • Vini Pavithran

摘要

Background

Hydroxychloroquine (HCQ), a 4-aminoquinoline originally developed as an antimalarial, is widely used as an immunomodulatory therapy in rheumatic diseases during pregnancy. It is recommended for women with Systemic lupus erythematosus (SLE) and Antiphospholipid syndrome (APS), with emerging interest in broader obstetric applications.

Objective

To synthesise current evidence on the pharmacology, mechanisms of action, clinical applications, and safety of HCQ in pregnancy and lactation, and to appraise its place in contemporary obstetric practice.

Methods

We conducted a structured narrative review of peer-reviewed literature indexed in PubMed, Embase, and the Cochrane Library (January 2005 to March 2026), and consultation of major international guidelines. Randomised controlled trials, cohort studies, systematic reviews, meta-analyses, mechanistic studies, and authoritative clinical guidelines were prioritised.

Findings

Current data support the safety of HCQ at doses ≤ 400 mg/day, with no consistent increase in major congenital malformations or adverse birth outcomes. HCQ reduces disease flares in SLE pregnancies, lowers the risk of preeclampsia, and improves live-birth rates in obstetric APS. Emerging but lower-certainty evidence suggests a possible benefit in antinuclear antibody–positive recurrent pregnancy loss and recurrent implantation failure. HCQ is compatible with breastfeeding. Evidence for use in recurrent pregnancy loss and implantation failure remains limited.

Conclusion

Current evidence affirms HCQ as a safe and effective pharmacotherapy in rheumatic disease pregnancies, with potential benefits in selected obstetric indications. Ongoing randomised trials are required.