Hydroxychloroquine for Recurrent Pregnancy Loss

Indications for Hydroxychloroquine

The American College of Rheumatology recommends adding hydroxychloroquine to standard therapy (aspirin + prophylactic heparin/LMWH) when pregnancy loss occurs despite standard treatment in patients with refractory obstetric antiphospholipid syndrome (OB APS) 1, 2, 3, 4
The American College of Rheumatology conditionally recommends adding hydroxychloroquine to prophylactic-dose heparin/LMWH and low-dose aspirin for patients with primary antiphospholipid syndrome (APS) 1, 2, 3
For patients with systemic lupus erythematosus (SLE), the American College of Rheumatology strongly recommends continuing hydroxychloroquine during pregnancy if already taking it, and conditionally recommends starting it if not taking it and no contraindications exist 5, 6, 7

The American College of Rheumatology conditionally recommends against treating with prophylactic hydroxychloroquine in pregnant women with positive antiphospholipid antibodies who do not meet APS criteria and lack another indication 8, 1, 2
Hydroxychloroquine should not be used as monotherapy, but rather added to standard anticoagulation therapy in APS 1, 2, 3
The American College of Rheumatology strongly recommends against adding prednisone to standard therapy for refractory OB APS due to lack of benefit and potential risks 1, 2, 4

The American College of Rheumatology recommends testing for antiphospholipid antibodies (LAC, aCL, anti-β2GPI) once before or early in pregnancy 5, 6, 7
Determine if patient meets formal criteria for OB APS or thrombotic APS 1, 2, 3
Screen for underlying SLE or other autoimmune diseases 5, 6

For confirmed OB APS, start low-dose aspirin (81-100 mg daily) + prophylactic-dose heparin/LMWH 1, 9, 2, 3, 6
For thrombotic APS, start low-dose aspirin + therapeutic-dose heparin/LMWH 1, 2, 3
Add hydroxychloroquine only if standard therapy has failed (pregnancy loss despite aspirin + heparin) or patient has primary APS or SLE 1, 2, 3, 4, 5, 6, 7