Background Nowadays there is a great variability in evaluation and management of patients with autoimmune and inflammatory diseases during fertility, pregnancy, post-partum and breastfeeding, in part due to lack of knowledge.
Objectives To develop recommendations on the evaluation and management of patients with autoimmune and inflammatory diseases during fertility, pregnancy, post-partum and breastfeeding based on the best evidence and experience.
Methods Recommendations were generated following nominal group methodology and Delphi technique. A panel of experts was established (12 rheumatologists). A systematic literature review and a narrative review (websites, clinical guidelines and other relevant documentation) were performed and presented to the panel in the 1st panel meeting to be discussed and to help define recommendations. A first draft of recommendations was generated and circulated for comments and wording refinements. A national survey analyzing different aspects of this topic was undertaken separately. Then, a Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence.
Results A total of 14 recommendations (see figure) were generated on the pre-conception period (oral and hormonal anticonception, reproductive techniques), pregnancy (planning, treatment and follow-up), and breastfeeding (treatment and follow-up). High risk situations were included as lupus or antiphospholipid syndrome. A consensus >90% was reached in all but one recommendation.
Conclusions These recommendations are intended to provide rheumatologists, patients, families and other stakeholders a consensus on the evaluation and management of patients with autoimmune and inflammatory diseases during fertility, pregnancy, post-partum and breastfeeding.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.