Recommendations for the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding.
OBJECTIVE
To develop recommendations on the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, post-partum and breastfeeding based on the best evidence and experience.


METHODS
Recommendations were generated using nominal group and Delphi techniques. An expert panel of 12 rheumatologists was established. A systematic literature review and a narrative review (websites, clinical guidelines and other relevant documentation) were performed and presented to the panel in its 1stmeeting to be discussed and to help define recommendations. A first draft of recommendations was generated and circulated for comments and wording refinement. A national survey analyzing different aspects of this topic was undertaken separately, followed by a Delphi process (2 rounds). Agreement with each recommendation was ranked on a scale of 1 (total disagreement) to 10 (total agreement), and was considered to be achieved if at least 70% voted≥7. The level of evidence and grade of recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence.


RESULTS
A total of 14 recommendations were generated for the preconception period (oral and hormonal contraception, reproductive techniques), pregnancy (planning, treatment and follow-up), and breastfeeding (treatment and follow-up). High-risk situations such as lupus or antiphospholipid syndrome were included. A consensus>90% was reached for all but one recommendation.


CONCLUSIONS
These recommendations are intended to provide rheumatologists, patients, families and other stakeholders with a consensus on the evaluation and management of patients with autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding.
Servicio de Reumatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España. Electronic address: jamartinez@idcsalud.es.
Juan Antonio
JA
Martínez López
Servicio de Reumatología, Hospital Universitario Basurto, Bilbao, España.
M Luz
ML
García Vivar
Unidad de Gestión de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, España.
Rafael
R
Cáliz
Servicio de Reumatología, Complexo hospitalario Universitario A Coruña (CHUAC), A Coruña, España.
Mercedes
M
Freire
Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, España.
María
M
Galindo
Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
Maria Victoria
MV
Hernández
Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Francisco Javier
FJ
López Longo
Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, España; Facultad de Medicina, Universidad de Cantabria, Santander, España.
Víctor
V
Martínez Taboada
Servicio de Reumatología, Hospital Meixoeiro-Complexo Hospitalario Universitario de Vigo, Vigo, España.
Jose María
JM
Pego Reigosa
Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Esteban
E
Rubio
Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
Elisa
E
Trujillo
Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, España.
Paloma
P
Vela-Casasempere
D001327:Autoimmune Diseases / Q000175:diagnosis / Q000628:therapy; D001942:Breast Feeding; D003697:Delphi Technique; D005260:Female; D006801:Humans; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy; D011295:Prenatal Care / Q000379:methods*; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000628:therapy; D013030:Spain
Biologic therapy; Disease modifying drugs; Embarazo; Enfermedad inflamatoria; Fármacos modificadores de la enfermedad; Inflammatory disease; Pregnancy; Terapia biológica