Pregnancy and Lactation

Therapy with chloroquine during pregnancy is discussed controversially. Chloro-quine was associated with sensorineural hearing loss, blindness, malformations, abortion, and, in vitro, chromosomal damage. The frequency of these events was calculated with 1.2%-3.3% (control group <1%). On the other hand, there are several reports on healthy newborns after chloroquine therapy of the mother. It is agreed that malaria prophylaxis (2x500 mg/week) should be continued during pregnancy. In the case of a planned conception, however, it was recommended to discontinue chloro-quine use in time. Here the potential risk of the treated disease, like activation of SLE (Wechsler et al. 1999),has tobe weighed individually against the possible chloroquine side effects (Parke and West 1996). Recently, it was not recommended any longer to discontinue antimalarials in pregnant patients with SLE (Borden and Parke 2001). In a series of 21 newborns of mothers using chloroquine (daily dose, 332 mg) or hydroxychloroquine (daily dose, 317 mg) during pregnancy, no eye changes or other birth defects in the offspring were found (Klinger et al. 2001). This study suggests that when chloroquine or hydroxychloroquine are required to control symptoms of rheumatologic diseases in pregnant women, the risk-benefit ratio is favorable (Klinger et al. 2001). In a placebo-controlled study, hydroxychloroquine had beneficial effects with no side effects in the newborns (Costedoat-Chalumeau et al. 2003, Levy et al. 2001). No malformations were reported after hydroxychloroquine use (Barthel et al. 1996, Ostensen and Ramsey-Golderman 1998).

Chloroquine is excreted with the mother's milk. The chloroquine concentration is about the same as in saliva. Within 24 h, a breastfed baby takes up ca. 0.55% of the mother's dose. For hydroxychloroquine, the dose is 2% of the maternal dose per kilogram per day (Canadian rheumatology association 2000).

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