title: Clinical practice guidelines for the management of pregnancy in women with autoimmune rheumatic diseases of the Mexican College of Rheumatology. Part II.
abstract: BACKGROUND
  Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients.
  
  
  OBJECTIVE
  To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS).
  
  
  METHODS
  Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed.
  
  
  RESULTS
  The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented.
  
  
  CONCLUSIONS
  We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions.
authors: Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS, UNAM, México, Distrito Federal, México. Electronic address: miansaavsa@gmail.com.
authors: Miguel Ángel
authors: MÁ
authors: Saavedra Salinas
authors: División de Excelencia Clínica, Área de Desarrollo de Guías de Práctica Clínica, IMSS, México, Distrito Federal, México.
authors: Antonio
authors: A
authors: Barrera Cruz
authors: Ciencias Médicas F, Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Distrito Federal, México.
authors: Antonio Rafael
authors: AR
authors: Cabral Castañeda
authors: Dirección de Educación e Investigación, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS, UNAM, México, Distrito Federal, México.
authors: Luis Javier
authors: LJ
authors: Jara Quezada
authors: División de Medicina Interna, Hospital Central Sur de Pemex, México, Distrito Federal, México.
authors: C Alejandro
authors: CA
authors: Arce-Salinas
authors: Escuela de Medicina, Universidad Anáhuac-Mayab, Mérida, Yucatán, México.
authors: José
authors: J
authors: Álvarez Nemegyei
authors: Dirección de Educación e Investigación, Secretaría de Salud del Distrito Federal, UNAM, México, Distrito Federal, México.
authors: Antonio
authors: A
authors: Fraga Mouret
authors: Clínica de Reumatología, Escuela de Medicina, Universidad de Guadalajara. Guadalajara, Jalisco, México.
authors: Javier
authors: J
authors: Orozco Alcalá
authors: División de Investigación en Salud, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara. Guadalajara, Jalisco, México.
authors: Mario
authors: M
authors: Salazar Páramo
authors: Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS, México, Distrito Federal, México.
authors: Claudia Verónica
authors: CV
authors: Cruz Reyes
authors: Departamento de Reumatología, Centro Médico Nacional 20 de Noviembre, ISSSTE. UNAM, México, Distrito Federal, México.
authors: Lilia
authors: L
authors: Andrade Ortega
authors: Departamento de Medicina Interna, Hospital de Especialidades, CMN La Raza, IMSS, UNAM, México, Distrito Federal, México.
authors: Olga Lidia
authors: OL
authors: Vera Lastra
authors: Unidad de Investigación Enfermedades Autoinmunes Sistémicas, Hospital General Regional No. 36-CIBIOR, Instituto Mexicano del Seguro Social. Unidad de Posgrado, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Puebla, México.
authors: Claudia
authors: C
authors: Mendoza Pinto
authors: Departamento de Reumatología, Hospital de Especialidades Dr. Antonio Fraga Mouret, CMN La Raza, IMSS, México, Distrito Federal, México.
authors: Antonio
authors: A
authors: Sánchez González
authors: División de Atención Ginecoobstétrica y Perinatal de la Dirección de Prestaciones Médicas del IMSS, México, Distrito Federal, México.
authors: Polita Del Rocío
authors: Pdel R
authors: Cruz Cruz
authors: Departamento de Perinatología, Hospital Gineco-Obstetricia No. 3 Dr. Víctor Manuel Espinosa de los Reyes Sánchez. UMAE, CMN La Raza, México, Distrito Federal, México.
authors: Sara
authors: S
authors: Morales Hernández
authors: Departamento de Reumatología, Hospital de Especialidades, CMN Siglo XXI, IMSS, México, Distrito Federal, México.
authors: Margarita
authors: M
authors: Portela Hernández
authors: Departamento de Reumatología, Hospital de Especialidades, CMN Siglo XXI, IMSS, México, Distrito Federal, México.
authors: Mario
authors: M
authors: Pérez Cristóbal
authors: Hospital de Especialidades, CMN La Raza, IMSS, México, Distrito Federal, México.
authors: Gabriela
authors: G
authors: Medina García
authors: Unidad de Cuidados Intensivos Neonatales. Hospital Gineco-Obstetricia No. 3 Dr. Víctor Manuel Espinosa de los Reyes Sánchez. UMAE, CMN La Raza, México, Distrito Federal, México.
authors: Noé
authors: N
authors: Hernández Romero
authors: Departamento de Reumatología e Inmunología Clínica, Hospital General de Zona No. 46, IMSS, Villahermosa, Tabasco, México.
authors: María Del Carmen
authors: Mdel C
authors: Velarde Ochoa
authors: Hospital General de Chilpancingo Dr. Raymundo Abarca Alarcón, Chilpancingo, Guerrero, México.
authors: José Eduardo
authors: JE
authors: Navarro Zarza
authors: Departamento de Medicina Interna, UMAE HGO 4, IMSS, México, Distrito Federal, México.
authors: Verónica
authors: V
authors: Portillo Díaz
authors: Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, México, Distrito Federal, México.
authors: Angélica
authors: A
authors: Vargas Guerrero
authors: Unidad de Investigación en Epidemiología Clínica, Hospital Regional Dr. Carlos Mcgregor Sánchez Navarro, IMSS, México, Distrito Federal, México.
authors: María Victoria
authors: MV
authors: Goycochea Robles
authors: Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México.
authors: José Luis
authors: JL
authors: García Figueroa
authors: Reumatología, Facultad de Medicina, Universidad Autónoma de Querétaro y Universidad del Valle de México. Querétaro, Qro., México.
authors: Eduardo
authors: E
authors: Barreira Mercado
authors: Reumatología, Centro Médico ABC, México, Distrito Federal, México.
authors: Mary Carmen
authors: MC
authors: Amigo Castañeda
mesh_terms: D000359:Aftercare / Q000379:methods; D016736:Antiphospholipid Syndrome / Q000175:diagnosis / Q000628:therapy*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000628:therapy*; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000628:therapy*; D008800:Mexico; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy*; D011295:Prenatal Care / Q000379:methods*
chemical_list: D018501:Antirheumatic Agents
keywords: Antiphospholipid antibody syndrome; Antirheumatic drugs; Artritis reumatoide; Clinical practice guidelines; Embarazo; Fármacos antirreumáticos; Guía de práctica clínica; Lactancia; Lactation; Pregnancy; Rheumatoid arthritis; Síndrome por anticuerpos antifosfolípidos