RT Journal Article
SR Electronic
T1 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
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 476
OP 485
DO 10.1136/annrheumdis-2016-209770
VO 76
IS 3
A1 L Andreoli
A1 G K Bertsias
A1 N Agmon-Levin
A1 S Brown
A1 R Cervera
A1 N Costedoat-Chalumeau
A1 A Doria
A1 R Fischer-Betz
A1 F Forger
A1 M F Moraes-Fontes
A1 M Khamashta
A1 J King
A1 A Lojacono
A1 F Marchiori
A1 P L Meroni
A1 M Mosca
A1 M Motta
A1 M Ostensen
A1 C Pamfil
A1 L Raio
A1 M Schneider
A1 E Svenungsson
A1 M Tektonidou
A1 S Yavuz
A1 D Boumpas
A1 A Tincani
YR 2017
UL http://ard.bmj.com/content/76/3/476.abstract
AB 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.