L Andreoli 1 , 2 , G K Bertsias 3 , N Agmon-Levin 4 , 5 , S Brown 6 , R Cervera 7 , N Costedoat-Chalumeau 8 , 9 , A Doria 10 , R Fischer-Betz 11 , F Forger 12 , M F Moraes-Fontes 13 , M Khamashta 14 , 15 , J King 16 , A Lojacono 1 , 17 , F Marchiori 18 , P L Meroni 19 , M Mosca 20 , M Motta 21 , M Ostensen 22 , C Pamfil 23 , L Raio 24 , M Schneider 11 , E Svenungsson 25 , M Tektonidou 26 , S Yavuz 27 , D Boumpas 28 , 29 , A Tincani 1 , 2
17 February 2017
Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS).
Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus.
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.