Which drug is primarily used for the management of systemic lupus erythematosus (SLE) during pregnancy?

Hydroxychloroquine is considered the primary drug for managing systemic lupus erythematosus (SLE) during pregnancy due to its safety profile and efficacy in controlling lupus symptoms. It is an antimalarial medication that possesses immunomodulatory properties, making it effective in reducing disease activity and preventing flares in patients with SLE.

During pregnancy, maintaining disease stability is crucial, as lupus can adversely affect both maternal and fetal outcomes. Hydroxychloroquine has been shown to be safe in pregnancy and does not pose significant risks to the developing fetus, which is why it is often preferred over other immunosuppressive therapies that may have more concerning side effects.

In contrast, while other medications like aspirin can have anticoagulant properties that may help in certain SLE-related complications such as fetal loss, they do not directly manage SLE. Azathioprine has some use in SLE management but carries potential risks during pregnancy, including fetal development concerns. Methotrexate (MTX) is contraindicated in pregnancy due to its teratogenic effects. Hence, hydroxychloroquine stands out as the most appropriate choice in the context of managing SLE in pregnant patients, prioritizing both maternal health and fetal safety.