A team of EULAR researchers published recommendations for health issues and family planning for women with lupus or antiphospholipid syndrome.
Laura Andreoli, PhD, in the Department of Clinical and Experimental Sciences at the University of Brescia in Italy, and colleagues performed a systematic review of evidence and compiled questions and expert opinions to reach a consensus. According to a published extended report, they made the following recommendations for women with lupus or antiphospholipid syndrome:
- family planning should be discussed after disease diagnosis;
- most women can have successful pregnancies, and steps can be taken to reduce adverse maternal or fetal outcomes;
- risk stratification includes disease activity, autoantibody profile, previous vascular morbidity, previous pregnancy morbidity, hypertension and drug use — with an emphasis on the use of hydroxychloroquine and anti-platelets or anti-coagulants;
- for patients with stable and inactive disease and a low risk for thrombosis, hormonal contraception and menopause replacement therapy can be used;
- fertility preservation with gonadotropin-releasing hormone analogues should be considered before use of alkylating agents;
- assisted reproduction techniques are safe for patients with stable and inactive disease;
- anticoagulants or low-dose aspirin should be given to patients with positive antiphospholipid antibodies;
- assessment of disease activity, renal function and serological markers is important to diagnose disease flares and monitor adverse obstetrical results;
- fetal monitoring includes Doppler ultrasonography and fetal biometry — especially in the third trimester — to screen for placental insufficiency and fetuses that are small given gestational age;
- gynecological malignancy screens are similar to that of the general population, but with increased vigilance for cervical premalignant lesions if patients exposed to immunosuppressive drugs; and
- the human papillomavirus vaccine can be given in women with stable and inactive disease. – by Will Offit
Disclosure : The researchers report no relevant financial disclosures.