Survey of antimalarial use in lupus pregnancy and lactation.

OBJECTIVE To obtain the experience of selected experts in the use of antimalarial drugs (AM) in pregnancy and lactation in systemic lupus erythematosus. METHODS Seventy-eight lupus experts identified from North America and UK were mailed a 19 question survey regarding their experience using AM in pregnancy and lactation. RESULTS The 52 (67%) respondents with usable questionnaires treated a median of 75 lupus patients/year, including 4-5 lupus pregnancies/year. Thirty-five (69%) continued AM sometimes, often, or always during pregnancy. Continuing AM increased with the number of pregnant lupus patients seen (p < 0.01). None reported having seen any fetal toxicity with AM use, and pregnancy was never terminated because of AM, other than at patient insistence (n = 1). Postpartum, 29 (63%) continued AM and advised breast-feeding. Responses were consistent among North American and UK experts. CONCLUSION The majority of lupus experts continue AM during pregnancy. This was particularly true for those who treated a larger number of pregnant lupus patients per year. The majority advise breast-feeding and continue AM postpartum. These practices are supported by the limited literature available.