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.
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.
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DOI：
10.1136/annrheumdis-2016-209770
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发表时间：
2017-03
影响因子：
27.4
通讯作者：
Tincani A
中科院分区：
文献类型：
--
作者：
Andreoli L;Bertsias GK;Agmon-Levin N;Brown S;Cervera R;Costedoat-Chalumeau N;Doria A;Fischer-Betz R;Forger F;Moraes-Fontes MF;Khamashta M;King J;Lojacono A;Marchiori F;Meroni PL;Mosca M;Motta M;Ostensen M;Pamfil C;Raio L;Schneider M;Svenungsson E;Tektonidou M;Yavuz S;Boumpas D;Tincani A
为系统性红斑狼疮(SLE)和/或抗磷脂综合征(APS)的妇女健康问题和计划生育提出建议。系统地审查证据，然后用改进的德尔菲法汇编问题，征求专家意见，并达成共识。确诊后应尽早讨论计划生育问题。大多数妇女都可以成功怀孕，可以采取措施降低产妇或胎儿不良结局的风险。风险分层包括疾病活动性、自身抗体谱、既往血管和妊娠发病率、高血压和药物使用(强调羟基氯喹和抗血小板/抗凝剂的益处)。激素避孕和更年期替代疗法可用于病情稳定/不活动且血栓形成风险较低的患者。在使用烷化剂之前，应考虑使用促性腺激素释放激素类似物来保存生育能力。辅助生殖技术可以安全地用于稳定期/非活动期疾病患者；抗磷脂抗体/APS阳性的患者应该接受抗凝和/或小剂量阿司匹林治疗。疾病活动性、肾功能和血清标志物的评估对于诊断疾病暴发和监测产科不良后果很重要。胎儿监测包括多普勒超声和胎儿生物测量，特别是在妊娠晚期，以筛查胎盘功能不全和胎龄较小的胎儿。妇科恶性肿瘤的筛查与普通人群相似，如果暴露于免疫抑制药物中，则会提高对宫颈癌前病变的警惕。人类乳头瘤病毒免疫接种可用于病情稳定/不活动的妇女。关于系统性红斑狼疮和/或初级保健方案中的妇女健康问题的建议是采用循证办法提出的，随后得到了专家的共识。
Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. 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. Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.