Juan Antonio Martínez López1, M Luz García Vivar2, Rafael Cáliz3, Mercedes Freire4, María Galindo5, Maria Victoria Hernández6, Francisco Javier López Longo7, Víctor Martínez Taboada8, Jose María Pego Reigosa9, Esteban Rubio10, Elisa Trujillo11, Paloma Vela-Casasempere12. 1. Servicio de Reumatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España. Electronic address: jamartinez@idcsalud.es. 2. Servicio de Reumatología, Hospital Universitario Basurto, Bilbao, España. 3. Unidad de Gestión de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, España. 4. Servicio de Reumatología, Complexo hospitalario Universitario A Coruña (CHUAC), A Coruña, España. 5. Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, España. 6. Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España. 7. Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España. 8. Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, España; Facultad de Medicina, Universidad de Cantabria, Santander, España. 9. Servicio de Reumatología, Hospital Meixoeiro-Complexo Hospitalario Universitario de Vigo, Vigo, España. 10. Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, España. 11. Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España. 12. Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, España.
Abstract
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 1st meeting 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.
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 1st meeting 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.
Authors: Leticia Leon; Marta Redondo; Antonio Fernández-Nebro; Susana Gómez; Estíbaliz Loza; María Montoro; Rosario Garcia-Vicuña; María Galindo Journal: Rheumatol Int Date: 2018-05-28 Impact factor: 2.631