ObjectiveTo determine pregnancy outcomes in women with systemic lupus erythematosus (SLE) who were treated with hydroxychloroquine in a tertiary center.MethodsA retrospective study involving pregnant women with SLE who had antenatal follow-up and delivery in between 1 January 2007 and 1 January 2017. All participants were retrospectively enrolled and categorized into two groups based on hydroxychloroquine treatment during pregnancy.ResultsThere were 82 pregnancies included with 47 (57.3%) in the hydroxychloroquine group and 35 (42.7%) in the non-hydroxychloroquine group. Amongst hydroxychloroquine users, there were significantly more pregnancies with musculoskeletal involvement (p= 0.03), heavier mean neonatal birthweight (p= 0.02), and prolonged duration of pregnancy (p= 0.001). In non-hydroxychloroquine patients, there were significantly more recurrent miscarriages (p= 0.003), incidence of hypertension (p= 0.01) and gestational diabetes mellitus (p= 0.01) and concurrent medical illness (p= 0.005). Hydroxychloroquine use during pregnancy was protective against hypertension (p= 0.001), and the gestational age at delivery had significant effect on the neonatal birthweight (p= 0.001). However, duration of the disease had a significant negative effect on the neonatal birthweight (p= 0.016).ConclusionHydroxychloroquine enhanced better neonatal outcomes and reduced adverse pregnancy outcomes and antenatal complications such as hypertension and diabetes.