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EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome
  1. L Andreoli1,2,
  2. G K Bertsias3,
  3. N Agmon-Levin4,5,
  4. S Brown6,
  5. R Cervera7,
  6. N Costedoat-Chalumeau8,9,
  7. A Doria10,
  8. R Fischer-Betz11,
  9. F Forger12,
  10. M F Moraes-Fontes13,
  11. M Khamashta14,15,
  12. J King16,
  13. A Lojacono1,17,
  14. F Marchiori18,
  15. P L Meroni19,
  16. M Mosca20,
  17. M Motta21,
  18. M Ostensen22,
  19. C Pamfil23,
  20. L Raio24,
  21. M Schneider11,
  22. E Svenungsson25,
  23. M Tektonidou26,
  24. S Yavuz27,
  25. D Boumpas28,29,
  26. A Tincani1,2
  1. 1Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
  2. 2Unit of Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
  3. 3Department of Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School, Heraklion, Greece
  4. 4The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
  5. 5The Faculty of Medicine, Tel Aviv University, Israel
  6. 6Royal National Hospital For Rheumatic Diseases, Bath, UK
  7. 7Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
  8. 8AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Paris, France
  9. 9Université Paris Descartes-Sorbonne Paris Cité, Paris, France
  10. 10Rheumatology Unit, Department of Medicine, University of Padua, Italy
  11. 11Policlinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
  12. 12Department of Rheumatology, Immunology and Allergology, University Hospital of Bern, Bern, Switzerland
  13. 13Unidade de Doenças Auto-imunes—Serviço Medicina Interna 7.2, Hospital Curry Cabral/Centro Hospitalar Lisboa Central, NEDAI/SPMI, Lisboa, Portugal
  14. 14Lupus Research Unit, The Rayne Institute, St. Thomas Hospital, London, UK
  15. 15Department of Rheumatology, Dubai Hospital, Dubai, United Arab Emirates
  16. 16EULAR PARE Patient Research Partner, London, UK
  17. 17Unit of Obstetrics and Gynaecology, Spedali Civili, Brescia, Italy
  18. 18EULAR PARE Patient Research Partner, Rome, Italy
  19. 19Department of Clinical Sciences and Community Health, University of Milan, Istituto Auxologico Italiano, Milan, Italy
  20. 20Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
  21. 21Neonatology and Neonatal Intensive Care Unit, Spedali Civili, Brescia, Italy
  22. 22Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  23. 23Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
  24. 24Department of Obstetrics and Gynaecology, University Hospital of Bern, Inselspital, Switzerland
  25. 25Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  26. 26Rheumatology Unit, Joint Academic Rheumatology Programme, 1st Department of Propaedeutic Internal Medicine Athens, National and Kapodistrian University of Athens, Athens, Greece
  27. 27Department of Rheumatology, Istanbul Bilim University, Istanbul Florence Nightingale Hospital, Esentepe-Istanbul, Turkey
  28. 284th Department of Internal Medicine, ‘Attikon’ University Hospital, Medical School, University of Athens, Athens, Greece
  29. 29Joint Academic Rheumatology Program, National and Kapodestrian University of Athens, Athens, Greece
  1. Correspondence to Professor Angela Tincani, Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Piazzale Spedali Civili, 1, Brescia 25123, Italy; angela.tincani{at}unibs.it

Abstract

Objectives Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).

Methods Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.

Results Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease.

Conclusions Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.

  • Antiphospholipid Antibodies
  • Antiphospholipid Syndrome
  • Multidisciplinary team-care
  • Systemic Lupus Erythematosus
  • Ultrasonography

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