title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.|Unit of Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy.
authors.forename: L
authors.identifier: http://orcid.org/0000-0002-9107-3218
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authors.lastname: Andreoli
authors.affiliation: Department of Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School, Heraklion, Greece.
authors.forename: G K
authors.initials: GK
authors.lastname: Bertsias
authors.affiliation: The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.|The Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Agmon-Levin
authors.affiliation: Royal National Hospital For Rheumatic Diseases, Bath, UK.
authors.forename: S
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authors.lastname: Brown
authors.affiliation: Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain.
authors.forename: R
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authors.lastname: Cervera
authors.affiliation: AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Paris, France.|Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
authors.forename: N
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authors.affiliation: Rheumatology Unit, Department of Medicine, University of Padua, Italy.
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authors.affiliation: Policlinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
authors.forename: R
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authors.affiliation: Department of Rheumatology, Immunology and Allergology, University Hospital of Bern, Bern, Switzerland.
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authors.affiliation: Unidade de Doenças Auto-imunes-Serviço Medicina Interna 7.2, Hospital Curry Cabral/Centro Hospitalar Lisboa Central, NEDAI/SPMI, Lisboa, Portugal.
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authors.initials: MF
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authors.affiliation: Lupus Research Unit, The Rayne Institute, St. Thomas Hospital, London, UK.|Department of Rheumatology, Dubai Hospital, Dubai, United Arab Emirates.
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authors.affiliation: EULAR PARE Patient Research Partner, London, UK.
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authors.affiliation: Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.|Unit of Obstetrics and Gynaecology, Spedali Civili, Brescia, Italy.
authors.forename: A
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authors.lastname: Lojacono
authors.affiliation: EULAR PARE Patient Research Partner, Rome, Italy.
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authors.initials: F
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authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Istituto Auxologico Italiano, Milan, Italy.
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authors.initials: PL
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authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: M
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authors.affiliation: Neonatology and Neonatal Intensive Care Unit, Spedali Civili, Brescia, Italy.
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authors.lastname: Raio
authors.affiliation: Policlinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
authors.forename: M
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authors.lastname: Schneider
authors.affiliation: Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: E
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authors.lastname: Svenungsson
authors.affiliation: Rheumatology Unit, Joint Academic Rheumatology Programme, 1st Department of Propaedeutic Internal Medicine Athens, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Tektonidou
authors.affiliation: Department of Rheumatology, Istanbul Bilim University, Istanbul Florence Nightingale Hospital, Esentepe-Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Yavuz
authors.affiliation: 4th Department of Internal Medicine, 'Attikon' University Hospital, Medical School, University of Athens, Athens, Greece.|Joint Academic Rheumatology Program, National and Kapodestrian University of Athens, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Boumpas
authors.affiliation: Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.|Unit of Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy.
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mesh_terms: D016736:Antiphospholipid Syndrome / Q000188:drug therapy*; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D003697:Delphi Technique; D055088:Early Detection of Cancer; D015914:Estrogen Replacement Therapy; D005193:Family Planning Services; D005260:Female; D059247:Fertility Preservation; D005323:Fetal Monitoring; D005833:Genital Neoplasms, Female / Q000175:diagnosis*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008593:Menopause; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D027724:Reproductive Techniques, Assisted; D018570:Risk Assessment
chemical_list: D003278:Contraceptives, Oral, Hormonal
keywords: Antiphospholipid Antibodies; Antiphospholipid Syndrome; Multidisciplinary team-care; Systemic Lupus Erythematosus; Ultrasonography