This sheet is about exposure to hydroxychloroquine in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.
What is hydroxychloroquine?
Hydroxychloroquine is a medication that has been approved for use to prevent and treat malaria and to treat autoimmune conditions, including rheumatoid arthritis and lupus. Plaquenil® is a brand name for hydroxychloroquine.
For more information on malaria, rheumatoid arthritis, and lupus, please see the MotherToBaby fact sheets at https://mothertobaby.org/fact-sheets/malaria/, https://mothertobaby.org/fact-sheets/rheumatoid-arthritis/, https://mothertobaby.org/fact-sheets/lupus-pregnancy/.
Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take this medication. Your healthcare providers can talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy.
The Society for Maternal Fetal Medicine (SMFM) has recommended that people who are pregnant and have lupus should continue or start hydroxychloroquine. For persons with lupus but no current symptoms or treatment, the SMFM has recommended talking with their healthcare providers regarding the benefits and limitations of starting or not starting this medication during pregnancy.
I take hydroxychloroquine. Can it make it harder for me to get pregnant?
Hydroxychloroquine has not been studied to see if it could make it harder to get pregnant. However, hydroxychloroquine might improve the success rates of certain fertility treatments.
Does taking hydroxychloroquine increase the chance for miscarriage?
Miscarriage is common and can occur in any pregnancy for many different reasons. Several studies have not found a higher chance of miscarriage related to hydroxychloroquine use. One study reported a higher number of miscarriages than expected, but the authors stated that the mother’s health conditions may have contributed to this finding since malaria and lupus can increase the chance of miscarriage.
Does taking hydroxychloroquine increase the chance of birth defects?
Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Most studies looking at the use of hydroxychloroquine to treat rheumatic disease in pregnancy have not found an increased chance for birth defects.
Does taking hydroxychloroquine in pregnancy increase the chance of other pregnancy-related problems?
Studies do not suggest that hydroxychloroquine increases the chance for pregnancy-related problems such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Having malaria or lupus in pregnancy might increase the chance for preterm delivery. Hydroxychloroquine might benefit pregnancies by reducing lupus.
Lupus in a person who is pregnant can lead to symptoms of lupus in the baby. The most serious complication of this neonatal lupus is a heart rhythm problem called congenital heart block. Hydroxychloroquine might reduce the chance of congenital heart block in pregnancies at increased chance for this condition.
Damage to the inner lining of the eye (called retinopathy) is an uncommon side effect of taking hydroxychloroquine. This has raised a theoretical concern that taking hydroxychloroquine in pregnancy could cause vision problems in the offspring. However, most studies on young children born to people who took hydroxychloroquine in pregnancy have not found an increase in eye problems.
Does taking hydroxychloroquine in pregnancy affect future behavior or learning for the child?
Studies have not been done to see if hydroxychloroquine can cause behavior or learning issues for the child.
Breastfeeding while taking hydroxychloroquine:
Hydroxychloroquine gets into breastmilk in small amounts. Studies on hydroxychloroquine in breastfeeding have reported no harmful effects on infants, including no effects on vision, hearing, or growth problems in children who were followed up to about 1 year of age. Be sure to talk to your healthcare provider about all your breastfeeding questions.
If a male takes hydroxychloroquine, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?
A review of studies on males who used medications to treat rheumatic disease at or near the time of conception did not find that hydroxychloroquine affected their fertility or pregnancy outcomes. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
MotherToBaby is currently conducting a study looking at autoimmune diseases and the medications used to treat autoimmune diseases in pregnancy. If you are interested in taking part in this study, please call 1-877-311-8972 or visit https://mothertobaby.org/join-study/.
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OTIS/MotherToBaby encourages inclusive and person-centered language. While our name still contains a reference to mothers, we are updating our resources with more inclusive terms. Use of the term mother or maternal refers to a person who is pregnant. Use of the term father or paternal refers to a person who contributes sperm.
