Recommendations for the evaluation and management of patients with rheumatic autoimmune and inflammatory diseases during the reproductive age, pregnancy, postpartum and breastfeeding
Por:
Martinez Lopez JA, Garcia Vivar ML, Caliz R, Freire M, Galindo M, Hernandez MV, Lopez Longo FJ, Martinez Taboada V, Pego Reigosa JM, Rubio E, Trujillo E and Vela C
Publicada:
1 sep 2017
Categoría:
Rheumatology
Resumen:
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 (web sites, 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. (C) 2016 Elsevier Espana, S.L.U. and Sociedad Espanola de Reumatologia y Colegio Mexicano de Reumatologia. All rights reserved.
Filiaciones:
Martinez Lopez JA:
Servicio de Reumatologia, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Espana
Garcia Vivar ML:
Servicio de Reumatologia, Hospital Universitario Basurto, Bilbao, Espana
Caliz R:
Unidad de Gestion de Reumatologia, Complejo Hospitalario Universitario de Granada, Granada, Espana
Freire M:
Servicio de Reumatologia, Complexo hospitalario Universitario A Coruna (CHUAC), A Coruna, Espana
Galindo M:
Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Espana
Hernandez MV:
Servicio de Reumatologia, Hospital Clinic de Barcelona, Barcelona, Espana
Lopez Longo FJ:
Servicio de Reumatologia, Hospital General Universitario Gregorio Maranon, Madrid, Espana
Martinez Taboada V:
Servicio de Reumatologia, Hospital Universitario Marques de Valdecilla, Santander, Espana
Facultad de Medicina, Universidad de Cantabria, Santander, Espana
Pego Reigosa JM:
Servicio de Reumatologia, Hospital Meixoeiro-Complexo Hospitalario Universitario de Vigo, Vigo, Espana
Rubio E:
Servicio de Reumatologia, Hospital Universitario Virgen del Rocio, Sevilla, Espana
Trujillo E:
Servicio de Reumatologia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Espana
Vela C:
Servicio de Reumatologia, Hospital General Universitario de Alicante, Alicante, Espana
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