This is the lay version of the EULAR recommendations for the management of women\u2019s health and family planning in women with lupus and\/or antiphospholipid syndrome. The original publication details the recommendations on use of medications, clinical focus points and treatment options. It can be downloaded from the EULAR website: www.eular.org.<\/p>\n
Andreoli L, et al. EULAR recommendations for women\u2019s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and\/or antiphospholipid syndrome. Ann Rheum Dis 2017;76:476\u2013485. doi:10.1136\/annrheumdis-2016-209770<\/p>\n
Introduction<\/strong> <\/p>\n What do we already know?<\/strong> What do the recommendations say?<\/strong> One star (*) means it is a weak recommendation with limited scientific evidence.<\/p>\n Two stars (**) means it is a weak recommendation with some scientific evidence.<\/p>\n Three stars (***) means it is a strong recommendation with some scientific evidence.<\/p>\n Four stars (****) means it is a strong recommendation with a lot of scientific evidence.<\/p>\n Summary<\/strong> Further reading<\/strong> Disclaimer:<\/strong>\u00a0This is a summary of a scientific article written by a medical professional (\u201cthe Original Article\u201d). The Summary is written to assist non medically trained readers to understand general points of the Original Article. It is supplied \u201cas is\u201d without any warranty. You should note that the Original Article (and Summary) may not be fully relevant nor accurate as medical science is constantly changing and errors can occur. It is therefore very important that readers not rely on the content in the Summary and consult their medical professionals for all aspects of their health care and only rely on the Summary if directed to do so by their medical professional. Please view our full\u00a0Website Terms and Conditions<\/a>.<\/p>\n Copyright \u00a9<\/strong>\u00a02017 BMJ Publishing Group Ltd & European League Against Rheumatism. Medical professionals may print copies for their and their patients and students non commercial use. Other individuals may print a single copy for their personal, non commercial use. For other uses please contact our\u00a0Rights and Licensing Team<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":" This is the lay version of the EULAR recommendations for the management of women\u2019s health and family planning in women with lupus and\/or antiphospholipid syndrome. The original publication details the recommendations on use of medications, clinical focus points and treatment options. It can be downloaded from the EULAR website: www.eular.org. Andreoli L, et al. EULAR […]<\/p>\n
\nRecommendations give advice to doctors and patients about the best way to treat and manage diseases. EULAR has written recommendations on family planning, pregnancy and menopause for women who have systemic lupus erythematosus (also called lupus or SLE) and\/or antiphospholipid syndrome (often shortened to APS).
\nThe recommendations were written by a multidisciplinary team of medical specialties, other healthcare providers and patient representatives. They looked at the scientific evidence on the management of people with lupus and\/or APS. They also discussed their expert opinion to achieve a level of agreement.<\/p>\n
\nLupus is an autoimmune disease that can affect the joints, skin and internal organs. Lupus is often linked to APS, which is characterised by increased levels of antiphospholipid antibodies in the blood. People with antiphospholipid antibodies have a higher than normal risk of getting blood clots and pregnancy losses. Women with lupus or APS are often diagnosed during their childbearing years. The disease can have an effect on a woman\u2019s ability to get pregnant and her chances of miscarriage. Lupus and some of the medications used for treatment increase the risk of complications during pregnancy, both for the mother and the baby.<\/p>\n
\nOverall, there are 12 main statements or recommendations. These recommendations recognise an important need for doctors to move away from undue caution against pregnancy for women with lupus, and instead to embrace pregnancy and help their patients to have children if they want them, provided that the individual risks for each patient are discussed. The recommendations aim to help you to manage your fertility, family planning and menopause. Each recommendation is based on available scientific evidence or expert opinion. The more stars a recommendation has the stronger the evidence is.<\/p>\n\n
\nYour doctor should talk to you about your contraceptive options, including the pill, a coil, or an implant. Using contraceptives is especially important to prevent unwanted pregnancies when your disease is very active or when you are taking drugs that could be dangerous for a foetus. A combined pill may not be suitable if you have APS, or if your doctor thinks you are at high risk of developing blood clots. In such cases, the progesterone-only pill and a coil may be suitable options.<\/li>\n
\nIf you wish to have a baby, either now or in the future, you should discuss general and disease-related risk factors with your doctor. Your lupus (especially lupus nephritis), your age, the drugs you take for your lupus, certain lifestyle exposures (such as tobacco use or alcohol consumption) may affect your ability to get pregnant. There may be lifestyle changes you can make to improve your fertility, such as limiting how much alcohol you drink, or stopping smoking.<\/li>\n
\nDrugs called alkylating agents (for example, cyclophosphamide) can affect your fertility. If your doctor prescribes you an alkylating agent, he\/she should also consider fertility preservation methods or drugs if you are still getting your period and might want to have a baby in the future.<\/li>\n
\nAs long as your lupus is stable or inactive, you can have in vitro fertilization (IVF) or treatments to help make you ovulate. If you have APS you might need to take medicines to prevent you getting blood clots, such as anticoagulation medications or low-dose aspirin.<\/li>\n
\nWhile you are pregnant, your doctor should assess your disease activity. This might include testing your kidney function or blood tests to check your antibody levels.<\/li>\n
\nYou may need to have more ultrasound scans than normal during your pregnancy to monitor the baby\u2019s development. This is especially important during your third trimester, to make sure that your baby is the right size, and that your placenta is working properly.<\/li>\n
\nDrugs such as hydroxychloroquine, oral glucocorticoids, azathioprine, ciclosporin A and tacrolimus can be used to prevent or manage flares of your lupus while you are pregnant. Other strategies such as glucocorticoid intravenous pulse therapy, intravenous immunoglobulin and plasmapheresis can be
\nused to manage moderate-to-severe flares. Mycophenolic acid, cyclophosphamide, leflunomide and methotrexate should be avoided because of their potential to cause malformations.<\/li>\n
\nWomen with lupus who are at risk of pre-eclampsia (especially those with disease that affects their kidneys, or who have tested positive for antiphospholipid antibodies) should receive low-dose aspirin. If you have APS you may need combination treatment with low-dose aspirin and heparin. Consider taking folic acid supplements when you plan to become pregnant or when you find out that you are pregnant. Check your vitamin D levels during the first trimester and discuss adequate vitamin D and
\ncalcium supplementation with your doctor.<\/li>\n
\nHormone replacement therapy (HRT) may be helpful when you reach the menopause and if you have severe symptoms that negatively impact on your quality of life. If you have antiphospholipid antibodies\u00a0in your blood, discuss with your doctor the benefits of HRT against the risk of you getting blood clots or heart disease.<\/li>\n
\nIf you have lupus, you may have a higher than normal risk of cervical premalignant lesions. You should attend all screening appointments. Your doctor may recommend a more intensive schedule if you are taking immunosuppressive drugs. Regarding breast, ovarian and endometrial malignancy, women with
\nSLE and\/or APS should undergo screening similar to the general population.<\/li>\n
\nThe HPV vaccine protects you against Human Papilloma Virus, a sexually transmitted infection which is linked to women developing cervical cancer. If you have lupus and\/or APS that is stable or inactive, you can receive the HPV vaccine as normal (according to local health policies).<\/li>\n<\/ul>\n
\nOverall, the recommendations say that it is important for you and your doctor to work together to help you manage your fertility, family planning and menopause. If you have lupus and\/or APS these recommendations will give you tips about what to expect from your doctor throughout your life and your pregnancies.
\nRecommendations with just 1 or 2 stars, which are based mainly on expert opinion and not backed up by appropriate clinical studies, may be as important as those with 3 and 4 stars. If you have any questions or concerns about your disease or your medication, you should speak to your doctor.<\/p>\n
\n1. Bertsias G, et al. EULAR recommendations for the management of systemic lupus erythematosus with
\nneuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical
\naffairs. Ann Rheum Dis 2010; 69(12): 2074\u201382. doi: 10.1136\/ard.2010.130476
\n2. Bertsias G, et al. Joint European League Against Rheumatism and European Renal Association-
\nEuropean Dialysis and Transplant Association (EULAR\/ERA-EDTA) recommendations for the
\nmanagement of adult and paediatric lupus nephritis. Ann Rheum Dis 2012;71(11): 1771\u201382.
\ndoi: 10.1136\/annrheumdis-2012-201940<\/p>\n