Hydroxychloroquine and the Prevention of Pregnancy Losses

Pregnancy loss is a common and devastating pregnancy complication. Recurrent early miscarriage (REM) isdefined as two or more consecutive pregnancy losses during the first trimester of pregnancy. It is a distinct entity and in approximately 50% of these patients, the underlying cause is never established. REM can be idiopathic, i.e. of unknown cause, be related to infections, anatomical or chromosomal abnormalities and can also be related to the presence of autoimmune connective tissue diseases or antiphospholipid antibodies (aPL). Hydroxychloroquine (HCQ) is an antimalarial immunomodulator and is currently being investigated for its role in the prevention of idiopathic REM and REM related to antiphospholipid antibodies (aPL). In this article we review the evidence that exists to date regarding the use of HCQ in the setting of unexplained REM and REM in relation to connective tissue diseases and aPL and antiphospholipid syndrome (APS).