https://doi.org/10.4081/reumatismo.2025.1752
The Italian Society for Rheumatology guidelines on reproductive health in patients with rheumatic diseases
Submitted: 7 June 2024
Accepted: 7 October 2024
Published: 12 February 2025
Accepted: 7 October 2024
Abstract Views: 224
PDF: 72
SUPPLEMENTARY MATERIAL: 7
SUPPLEMENTARY MATERIAL: 7
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective. To date, there is no shared national guideline in Italy for the management of reproductive health in rheumatic diseases (RHRD). The Italian Society for Rheumatology has committed to developing clinical practice recommendations to provide guidance on both management and treatment regarding RHRD in Italy.
Methods. Using the GRADE-ADOLOPMENT methodology, a systematic literature review was conducted to update the scientific evidence that emerged after the publication of the reference recommendations from the American College of Rheumatology. A multidisciplinary group of 18 clinicians with specialist experience in rheumatology, allergy and clinical immunology, internal medicine, nephrology, gynecology and obstetrics, and neonatology, a professional nurse, a clinical psychologist, and a representative from the National Association of Rheumatic Patients discussed the recommendations in collaboration with the evidence review working group. Subsequently, a group of stakeholders was consulted to examine and externally evaluate the developed recommendations.
Results. Recommendations were formulated for each area of interest: contraception, assisted reproductive technology, preconception counseling, and use of drugs before, during, and after pregnancy and during breastfeeding, considering both paternal and maternal exposure.
Conclusions. The new SIR recommendations provide the rheumatology community with a practical guide based on updated scientific evidence for the management of RHRD.
ISTAT. Documento ISTAT del 19 dicembre 2022 2022. Available from: https://www.regioni.it/newsletter/n-4425/del-19-12-2022/istat-natalita-in-ribasso-in-tutte-le-regioni-25062/. [Material in Italian].
Chakravarty E, Clowse ME, Pushparajah DS, Mertens S, Gordon C. Family planning and pregnancy issues for women with systemic inflammatory diseases: patient and physician perspectives. BMJ Open 2014; 4: e004081.
DOI: https://doi.org/10.1136/bmjopen-2013-004081
Andreoli L, Lazzaroni MG, Carini C, Dall’Ara F, Nalli C, Reggia R, et al. “Disease knowledge index” and perspectives on reproductive issues: a nationwide study on 398 women with autoimmune rheumatic diseases. Joint Bone Spine 2019; 86: 475-81.
DOI: https://doi.org/10.1016/j.jbspin.2018.12.002
Andreoli L, Bertsias GK, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, et al. 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. Ann Rheum Dis 2017; 76: 476-85.
DOI: https://doi.org/10.1136/annrheumdis-2016-209770
Wallenius M, Salvesen KA, Daltveit AK, Skomsvoll JF. Miscarriage and stillbirth in women with rheumatoid arthritis. J Rheumatol 2015; 42: 1570-2.
DOI: https://doi.org/10.3899/jrheum.141553
Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: a meta-analysis of studies published between years 2001-2016. J Autoimmun 2017; 79: 17-27.
DOI: https://doi.org/10.1016/j.jaut.2017.02.009
Buyon JP, Kim MY, Guerra MM, Laskin CA, Petri M, Lockshin MD, et al. Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann Intern Med 2015; 163: 153-63.
DOI: https://doi.org/10.7326/M14-2235
Jethwa H, Lam S, Smith C, Giles I. Does rheumatoid arthritis really improve during pregnancy? A systematic review and metaanalysis. J Rheumatol 2019; 46: 245-50.
DOI: https://doi.org/10.3899/jrheum.180226
Hamroun S, Hamroun A, Bigna JJ, Allado E, Forger F, Molto A. Fertility and pregnancy outcomes in women with spondyloarthritis: a systematic review and meta-analysis. Rheumatology 2022; 61: 1314-27.
DOI: https://doi.org/10.1093/rheumatology/keab589
Gotestam Skorpen C, Hoeltzenbein M, Tincani A, Fischer-Betz R, Elefant E, Chambers C, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 2016; 75: 795-810.
DOI: https://doi.org/10.1136/annrheumdis-2015-208840
Sammaritano LR, Bermas BL, Chakravarty EE, Chambers C, Clowse MEB, Lockshin MD, et al. 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol 2020; 72: 529-56.
DOI: https://doi.org/10.1002/art.41191
Russell MD, Dey M, Flint J, Davie P, Allen A, Crossley A, et al. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: immunomodulatory anti-rheumatic drugs and corticosteroids. Rheumatology 2023; 62: e48-88.
DOI: https://doi.org/10.1093/rheumatology/keac686
Schreiber K, Frishman M, Russell MD, Dey M, Flint J, Allen A, et al. British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: comorbidity medications used in rheumatology practice. Rheumatology 2023; 62: e89-e104.
DOI: https://doi.org/10.1093/rheumatology/keac700
Schunemann HJ, Wiercioch W, Brozek J, Etxeandia-Ikobaltzeta I, Mustafa RA, Manja V, et al. GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol 2017; 81: 101-10.
DOI: https://doi.org/10.1016/j.jclinepi.2016.09.009
CNEC. Manuale metodologico per la produzione di linee guida di pratica clinica.
CNEC. Manuale operativo per la produzione di linee guida di pratica clinica. 2020.
SIR. Raccomandazioni della Società Italiana di Reumatologia sulla salute riproduttiva dei pazienti affetti da malattie reumatologiche. 2023.
Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; 355: i4919.
DOI: https://doi.org/10.1136/bmj.i4919
Sterne JAC, Savovic J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898.
DOI: https://doi.org/10.1136/bmj.l4898
Hayden JA, van der Windt DA, Cartwright JL, Cote P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med 2013; 158: 280-6.
DOI: https://doi.org/10.7326/0003-4819-158-4-201302190-00009
Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. J Clin Epidemiol 2010; 63: 1308-11.
DOI: https://doi.org/10.1016/j.jclinepi.2010.07.001
Sanchez-Guerrero J, Uribe AG, Jimenez-Santana L, Mestanza-Peralta M, Lara-Reyes P, Seuc AH, Cravioto MD. A trial of contraceptive methods in women with systemic lupus erythematosus. N Engl J Med 2005; 353: 2539-49.
DOI: https://doi.org/10.1056/NEJMoa050817
Julkunen H, Kurki P, Kaaja R, Heikkila R, Immonen I, Chan EK, et al. Isolated congenital heart block. Long-term outcome of mothers and characterization of the immune response to SS-A/Ro and to SS-B/La. Arthritis Rheum 1993; 36: 1588-98.
DOI: https://doi.org/10.1002/art.1780361114
Julkunen HA. Oral contraceptives in systemic lupus erythematosus: side-effects and influence on the activity of SLE. Scand J Rheumatol 1991; 20: 427-33.
DOI: https://doi.org/10.3109/03009749109096822
Chabbert-Buffet N, Amoura Z, Scarabin PY, Frances C, Levy DP, Galicier L, et al. Pregnane progestin contraception in systemic lupus erythematosus: a longitudinal study of 187 patients. Contraception 2011; 83: 229-37.
DOI: https://doi.org/10.1016/j.contraception.2010.08.012
Petri M, Kim MY, Kalunian KC, Grossman J, Hahn BH, Sammaritano LR, et al. Combined oral contraceptives in women with systemic lupus erythematosus. N Engl J Med 2005; 353: 2550-8.
DOI: https://doi.org/10.1056/NEJMoa051135
Lakasing L, Spencer JA. Care management problems on the labour ward: 5 years' experience of clinical risk management. J Obstet Gynaecol 2002; 22: 470-6.
DOI: https://doi.org/10.1080/0144361021000003564
Jungers P, Liote F, Dautzenberg MD, Gazengel C, Dougados M, Tron F, Bach JF. Lupus anticoagulant and thrombosis in systemic lupus erythematosus. Lancet 1984; 1: 574-5.
DOI: https://doi.org/10.1016/S0140-6736(84)90982-6
Jungers P, Dougados M, Pelissier C, Kuttenn F, Tron F, Lesavre P, Bach JF. Influence of oral contraceptive therapy on the activity of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 618-23.
DOI: https://doi.org/10.1002/art.1780250603
Lakasing L, Khamashta M. Contraceptive practices in women with systemic lupus erythematosus and/or antiphospholipid syndrome: what advice should we be giving? J Fam Plann Reprod Health Care 2001; 27: 7-12.
DOI: https://doi.org/10.1783/147118901101195029
Guballa N, Sammaritano L, Schwartzman S, Buyon J, Lockshin MD. Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome. Arthritis Rheum 2000; 43: 550-6.
DOI: https://doi.org/10.1002/1529-0131(200003)43:3<550::AID-ANR10>3.0.CO;2-Y
Moroni G, Doria A, Giglio E, Tani C, Zen M, Strigini F, et al. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century. A prospective multicenter study. J Autoimmun 2016; 74: 6-12.
DOI: https://doi.org/10.1016/j.jaut.2016.07.010
Weber-Schoendorfer C, Hoeltzenbein M, Wacker E, Meister R, Schaefer C. No evidence for an increased risk of adverse pregnancy outcome after paternal low-dose methotrexate: an observational cohort study. Rheumatology 2014; 53: 757-63.
DOI: https://doi.org/10.1093/rheumatology/ket390
Clowse ME, Wolf DC, Forger F, Cush JJ, Golembesky A, Shaughnessy L, et al. Pregnancy outcomes in subjects exposed to certolizumab pegol. J Rheumatol 2015; 42: 2270-8.
DOI: https://doi.org/10.3899/jrheum.140189
Cassina M, Johnson DL, Robinson LK, Braddock SR, Xu R, Jimenez JL, et al. Pregnancy outcome in women exposed to leflunomide before or during pregnancy. Arthritis Rheum 2012; 64: 2085-94.
DOI: https://doi.org/10.1002/art.34419
Lewden B, Vial T, Elefant E, Nelva A, Carlier P, Descotes J, French Network of Regional Pharmacovigilance C. Low dose methotrexate in the first trimester of pregnancy: results of a French collaborative study. J Rheumatol 2004; 31: 2360-5.
Weber-Schoendorfer C, Beck E, Tissen-Diabate T, Schaefer C. Leflunomide - a human teratogen? A still not answered question. An evaluation of the German Embryotox pharmacovigilance database. Reprod Toxicol 2017; 71: 101-7.
DOI: https://doi.org/10.1016/j.reprotox.2017.04.007
Viktil KK, Engeland A, Furu K. Outcomes after anti-rheumatic drug use before and during pregnancy: a cohort study among 150,000 pregnant women and expectant fathers. Scand J Rheumatol 2012; 41: 196-201.
DOI: https://doi.org/10.3109/03009742.2011.626442
Cooper WO, Cheetham TC, Li DK, Stein CM, Callahan ST, Morgan TM, et al. Brief report: risk of adverse fetal outcomes associated with immunosuppressive medications for chronic immune-mediated diseases in pregnancy. Arthritis Rheumatol 2014; 66: 444-50.
DOI: https://doi.org/10.1002/art.38262
Chambers CD, Johnson DL, Robinson LK, Braddock SR, Xu R, Lopez-Jimenez J, et al. Birth outcomes in women who have taken leflunomide during pregnancy. Arthritis Rheum 2010; 62: 1494-503.
DOI: https://doi.org/10.1002/art.27358
Strandberg L, Salomonsson S, Bremme K, Sonesson S, Wahren-Herlenius M. Ro52, Ro60 and La IgG autoantibody levels and Ro52 IgG subclass profiles longitudinally throughout pregnancy in congenital heart block risk pregnancies. Lupus 2006; 15: 346-53.
DOI: https://doi.org/10.1191/0961203306lu2309oa
Neri F, Chimini L, Filippini E, Motta M, Faden D, Tincani A. Pregnancy in patients with rheumatic diseases: psychological implication of a chronic disease and neuropsychological evaluation of the children. Lupus 2004; 13: 666-8.
DOI: https://doi.org/10.1191/0961203303lu2003oa
Buyon JP, Winchester RJ, Slade SG, Arnett F, Copel J, Friedman D, Lockshin MD. Identification of mothers at risk for congenital heart block and other neonatal lupus syndromes in their children. Comparison of enzyme-linked immunosorbent assay and immunoblot for measurement of anti-SS-A/Ro and anti-SS-B/La antibodies. Arthritis Rheum 1993; 36: 1263-73.
DOI: https://doi.org/10.1002/art.1780360911
Chakravarty EF, Colon I, Langen ES, Nix DA, El-Sayed YY, Genovese MC, Druzin ML. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am J Obstet Gynecol 2005; 192: 1897-904.
DOI: https://doi.org/10.1016/j.ajog.2005.02.063
Ginsberg JS, Brill-Edwards P, Johnston M, Denburg JA, Andrew M, Burrows RF, et al. Relationship of antiphospholipid antibodies to pregnancy loss in patients with systemic lupus erythematosus: a cross-sectional study. Blood 1992; 80: 975-80.
DOI: https://doi.org/10.1182/blood.V80.4.975.bloodjournal804975
Kobayashi N, Yamada H, Kishida T, Kato EH, Ebina Y, Sakuragi N, et al. Hypocomplementemia correlates with intrauterine growth retardation in systemic lupus erythematosus. Am J Reprod Immunol 1999; 42: 153-9.
DOI: https://doi.org/10.1111/j.1600-0897.1999.tb00479.x
Tian X, Li M, Ye Z, Zhang X, Liu S, Wu L, et al. Related factors of fetal loss in Chinese women with systemic lupus erythematosus: data from Chinese SLE Treatment and Research Group registry IV. Int J Rheum Dis 2015; 18: 654-60.
DOI: https://doi.org/10.1111/1756-185X.12542
Zhan Z, Yang Y, Zhan Y, Chen D, Liang L, Yang X. Fetal outcomes and associated factors of adverse outcomes of pregnancy in southern Chinese women with systemic lupus erythematosus. PLoS One 2017; 12: e0176457.
DOI: https://doi.org/10.1371/journal.pone.0176457
Friedman DM, Llanos C, Izmirly PM, Brock B, Byron J, Copel J, et al. Evaluation of fetuses in a study of intravenous immunoglobulin as preventive therapy for congenital heart block: Results of a multicenter, prospective, open-label clinical trial. Arthritis Rheum 2010; 62: 1138-46.
DOI: https://doi.org/10.1002/art.27308
Kim H, Lee JW, Kang HJ, Park HJ, Kim YY, Shin HY, et al. Clinical results of chemotherapy based treatment in retinoblastoma patients: a single center experience. Cancer Res Treat 2008; 40: 164-71.
DOI: https://doi.org/10.4143/crt.2008.40.4.164
Saccone G, Berghella V, Maruotti GM, Ghi T, Rizzo G, Simonazzi G, et al. Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome: the PREGNANTS study. Am J Obstet Gynecol 2017; 216: 525.e1-e12.
DOI: https://doi.org/10.1016/j.ajog.2017.01.026
Mecacci F, Bianchi B, Pieralli A, Mangani B, Moretti A, Cioni R, et al. Pregnancy outcome in systemic lupus erythematosus complicated by anti-phospholipid antibodies. Rheumatology 2009; 48: 246-9.
DOI: https://doi.org/10.1093/rheumatology/ken458
Clowse ME, Magder L, Petri M. Cyclophosphamide for lupus during pregnancy. Lupus 2005; 14: 593-7.
DOI: https://doi.org/10.1191/0961203305lu2169oa
Munoz-Rodriguez FJ, Reverter JC, Font J, Tassies D, Espinosa G, Cervera R, et al. Clinical significance of acquired activated protein C resistance in patients with systemic lupus erythematosus. Lupus 2002; 11: 730-5.
DOI: https://doi.org/10.1191/0961203302lu256oa
Le Thi Huong D, Wechsler B, Piette JC, Bletry O, Godeau P. Pregnancy and its outcome in systemic lupus erythematosus. QJM 1994; 87: 721-9.
DOI: https://doi.org/10.1093/oxfordjournals.qjmed.a068889
Buchanan NM, Khamashta MA, Morton KE, Kerslake S, Baguley EA, Hughes GR. A study of 100 high risk lupus pregnancies. Am J Reprod Immunol 1992; 28: 192-4.
DOI: https://doi.org/10.1111/j.1600-0897.1992.tb00789.x
Hendawy SF, Abdel-Mohsen D, Ebrahim SE, Ewais H, Moussa SH, Khattab DA, et al. Pregnancy related complications in patients with systemic lupus erythematosus, an egyptian experience. Clin Med Insights Reprod Health 2011; 5: 17-24.
DOI: https://doi.org/10.4137/CMRH.S6862
Madazli R, Yuksel MA, Oncul M, Imamoglu M, Yilmaz H. Obstetric outcomes and prognostic factors of lupus pregnancies. Arch Gynecol Obstet 2014; 289: 49-53.
DOI: https://doi.org/10.1007/s00404-013-2935-4
Kroese SJ, de Hair MJH, Limper M, Lely AT, van Laar JM, Derksen R, Fritsch-Stork RDE. Hydroxychloroquine use in lupus patients during pregnancy is associated with longer pregnancy duration in preterm births. J Immunol Res 2017; 2017: 2810202.
DOI: https://doi.org/10.1155/2017/2810202
Rahman FZ, Rahman J, Al-Suleiman SA, Rahman MS. Pregnancy outcome in lupus nephropathy. Arch Gynecol Obstet 2005; 271: 222-6.
DOI: https://doi.org/10.1007/s00404-003-0574-x
Clark CA, Spitzer KA, Nadler JN, Laskin CA. Preterm deliveries in women with systemic lupus erythematosus. J Rheumatol 2003; 30: 2127-32.
Barsalou J, Jaeggi E, Laskin CA, Brown P, Tian SY, Hamilton RM, Silverman ED. Prenatal exposure to antimalarials decreases the risk of cardiac but not non-cardiac neonatal lupus: a single-centre cohort study. Rheumatology 2017; 56: 1552-9.
DOI: https://doi.org/10.1093/rheumatology/kex191
Martinez-Sanchez N, Perez-Pinto S, Robles-Marhuenda A, Arnalich-Fernandez F, Martin Camean M, Hueso Zalvide E, Bartha JL. Obstetric and perinatal outcome in anti-Ro/SSA-positive pregnant women: a prospective cohort study. Immunol Res 2017; 65: 487-94.
DOI: https://doi.org/10.1007/s12026-016-8888-5
Al Arfaj AS, Khalil N. Pregnancy outcome in 396 pregnancies in patients with SLE in Saudi Arabia. Lupus 2010; 19: 1665-73.
DOI: https://doi.org/10.1177/0961203310378669
Whitelaw DA, Hall D, Kotze T. Pregnancy in systemic lupus erythematosus: a retrospective study from a developing community. Clin Rheumatol 2008; 27: 577-80.
DOI: https://doi.org/10.1007/s10067-007-0749-0
Rezk M, Ellakwa H, Al-Halaby A, Shaheen A, Zahran A, Badr H. Predictors of poor obstetric outcome in women with systemic lupus erythematosus: a 10-year experience of a university hospital. J Matern Fetal Neonatal Med 2017; 30: 2031-5. Retraction in: J Matern Fetal Neonatal Med 2023; 36: 2235776.
DOI: https://doi.org/10.1080/14767058.2016.1236244
Carmona F, Font J, Cervera R, Munoz F, Cararach V, Balasch J. Obstetrical outcome of pregnancy in patients with systemic Lupus erythematosus. A study of 60 cases. Eur J Obstet Gynecol Reprod Biol 1999; 83: 137-42.
DOI: https://doi.org/10.1016/S0301-2115(98)00312-1
Lima F, Buchanan NM, Khamashta MA, Kerslake S, Hughes GR. Obstetric outcome in systemic lupus erythematosus. Semin Arthritis Rheum 1995; 25: 184-92.
DOI: https://doi.org/10.1016/S0049-0172(95)80030-1
Teh CL, Wong JS, Ngeh NK, Loh WL. Systemic lupus erythematosus pregnancies: a case series from a tertiary, East Malaysian hospital. Lupus 2009; 18: 278-82.
DOI: https://doi.org/10.1177/0961203308096661
Mokbel A, Gellan AM, AboElgheit S. Could women with systemic lupus erythematosus (SLE) have successful pregnancy outcomes? Prospective observational study. Egyptian Rheumatologist 2013; 35: 133-9.
DOI: https://doi.org/10.1016/j.ejr.2013.02.002
Ambrosio P, Lermann R, Cordeiro A, Borges A, Nogueira I, Serrano F. Lupus and pregnancy--15 years of experience in a tertiary center. Clin Rev Allergy Immunol 2010; 38: 77-81.
DOI: https://doi.org/10.1007/s12016-009-8139-9
Aly EAH RR, Mokbel AN. Pregnancy outcome in patients with systemic lupus erythematosus: a single center study in the High Risk Pregnancy unit. Middle East Fertil Soc J 2016; 21: 168-74.
DOI: https://doi.org/10.1016/j.mefs.2015.12.003
Gladman G, Silverman ED, Yuk L, Luy L, Boutin C, Laskin C, Smallhorn JF. Fetal echocardiographic screening of pregnancies of mothers with anti-Ro and/or anti-La antibodies. Am J Perinatol 2002; 19: 73-80.
DOI: https://doi.org/10.1055/s-2002-23555
Trucco SM, Jaeggi E, Cuneo B, Moon-Grady AJ, Silverman E, Silverman N, Hornberger LK. Use of intravenous gamma globulin and corticosteroids in the treatment of maternal autoantibody-mediated cardiomyopathy. J Am Coll Cardiol 2011; 57: 715-23.
DOI: https://doi.org/10.1016/j.jacc.2010.09.044
Cuneo BF, Lee M, Roberson D, Niksch A, Ovadia M, Parilla BV, Benson DW. A management strategy for fetal immune-mediated atrioventricular block. J Matern Fetal Neonatal Med 2010; 23: 1400-5.
DOI: https://doi.org/10.3109/14767051003728237
Tunks RD, Clowse ME, Miller SG, Brancazio LR, Barker PC. Maternal autoantibody levels in congenital heart block and potential prophylaxis with antiinflammatory agents. Am J Obstet Gynecol 2013; 208: 64.e1-7.
DOI: https://doi.org/10.1016/j.ajog.2012.09.020
Brucato A, Frassi M, Franceschini F, Cimaz R, Faden D, Pisoni MP, et al. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum 2001; 44: 1832-5.
DOI: https://doi.org/10.1002/1529-0131(200108)44:8<1832::AID-ART320>3.0.CO;2-C
Saleeb S, Copel J, Friedman D, Buyon JP. Comparison of treatment with fluorinated glucocorticoids to the natural history of autoantibody-associated congenital heart block: retrospective review of the research registry for neonatal lupus. Arthritis Rheum 1999; 42: 2335-45.
DOI: https://doi.org/10.1002/1529-0131(199911)42:11<2335::AID-ANR12>3.0.CO;2-3
Izmirly PM, Costedoat-Chalumeau N, Pisoni CN, Khamashta MA, Kim MY, Saxena A, et al. Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 2012; 126: 76-82.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.111.089268
Izmirly PM, Kim MY, Llanos C, Le PU, Guerra MM, Askanase AD, et al. Evaluation of the risk of anti-SSA/Ro-SSB/La antibody-associated cardiac manifestations of neonatal lupus in fetuses of mothers with systemic lupus erythematosus exposed to hydroxychloroquine. Ann Rheum Dis 2010; 69: 1827-30.
DOI: https://doi.org/10.1136/ard.2009.119263
Pisoni CN, Brucato A, Ruffatti A, Espinosa G, Cervera R, Belmonte-Serrano M, et al. Failure of intravenous immunoglobulin to prevent congenital heart block: findings of a multicenter, prospective, observational study. Arthritis Rheum 2010; 62: 1147-52.
DOI: https://doi.org/10.1002/art.27350
Ku M, Guo S, Shang W, Li Q, Zeng R, Han M, et al. Pregnancy outcomes in Chinese patients with systemic lupus erythematosus (SLE): a retrospective study of 109 pregnancies. PLoS One 2016; 11: e0159364.
DOI: https://doi.org/10.1371/journal.pone.0159364
Jaeggi ET, Silverman ED, Laskin C, Kingdom J, Golding F, Weber R. Prolongation of the atrioventricular conduction in fetuses exposed to maternal anti-Ro/SSA and anti-La/SSB antibodies did not predict progressive heart block. A prospective observational study on the effects of maternal antibodies on 165 fetuses. J Am Coll Cardiol 2011; 57: 1487-92.
DOI: https://doi.org/10.1016/j.jacc.2010.12.014
Shinohara K, Miyagawa S, Fujita T, Aono T, Kidoguchi K. Neonatal lupus erythematosus: results of maternal corticosteroid therapy. Obstet Gynecol 1999; 93: 952-7.
DOI: https://doi.org/10.1097/00006250-199906000-00012
Friedman DM, Kim MY, Copel JA, Davis C, Phoon CK, Glickstein JS, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR interval and dexamethasone evaluation (PRIDE) prospective study. Circulation 2008; 117: 485-93.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.707661
Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, et al. Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing committee of the American Society for Apheresis: the eighth special issue. J Clin Apher 2019; 34: 171-354.
DOI: https://doi.org/10.1002/jca.21705
Pattison NS, Chamley LW, Birdsall M, Zanderigo AM, Liddell HS, McDougall J. Does aspirin have a role in improving pregnancy outcome for women with the antiphospholipid syndrome? A randomized controlled trial. Am J Obstet Gynecol 2000; 183: 1008-12.
DOI: https://doi.org/10.1067/mob.2000.106754
Out HJ, Bruinse HW, Christiaens GC, van Vliet M, de Groot PG, Nieuwenhuis HK, Derksen RH. A prospective, controlled multicenter study on the obstetric risks of pregnant women with antiphospholipid antibodies. Am J Obstet Gynecol 1992; 167: 26-32.
DOI: https://doi.org/10.1016/S0002-9378(11)91619-6
Cowchock S, Reece EA. Do low-risk pregnant women with antiphospholipid antibodies need to be treated? Organizing Group of the Antiphospholipid Antibody Treatment Trial. Am J Obstet Gynecol 1997; 176: 1099-100.
DOI: https://doi.org/10.1016/S0002-9378(97)70409-5
Lockshin MD. Pregnancy does not cause systemic lupus erythematosus to worsen. Arthritis Rheum 1989; 32: 665-70.
DOI: https://doi.org/10.1002/anr.1780320602
Del Ross T, Ruffatti A, Visentin MS, Tonello M, Calligaro A, Favaro M, et al. Treatment of 139 pregnancies in antiphospholipid-positive women not fulfilling criteria for antiphospholipid syndrome: a retrospective study. J Rheumatol 2013; 40: 425-9.
DOI: https://doi.org/10.3899/jrheum.120576
Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ 1997; 314: 253-7.
DOI: https://doi.org/10.1136/bmj.314.7076.253
Goel N, Tuli A, Choudhry R. The role of aspirin versus aspirin and heparin in cases of recurrent abortions with raised anticardiolipin antibodies. Med Sci Monit 2006; 12: CR132-6.
Schreiber K, Breen K, Cohen H, Jacobsen S, Middeldorp S, Pavord S, et al. Hydroxychloroquine to improve pregnancy outcome in women with antiphospholipid antibodies (HYPATIA) protocol: a multinational randomized controlled trial of hydroxychloroquine versus placebo in addition to standard treatment in pregnant women with antiphospholipid syndrome or antibodies. Semin Thromb Hemost 2017; 43: 562-71.
DOI: https://doi.org/10.1055/s-0037-1603359
Bao SH, Sheng SL, Liao H, Zhou Q, Frempong ST, Tu WY. Use of D-dimer measurement to guide anticoagulant treatment in recurrent pregnancy loss associated with antiphospholipid syndrome. Am J Reprod Immunol 2017; 78. doi: 10.1111/aji.12770.
DOI: https://doi.org/10.1111/aji.12770
Farquharson RG, Quenby S, Greaves M. Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstet Gynecol 2002; 100: 408-13.
DOI: https://doi.org/10.1097/00006250-200209000-00004
van Hoorn ME, Hague WM, van Pampus MG, Bezemer D, de Vries JI, Investigators F. Low-molecular-weight heparin and aspirin in the prevention of recurrent early-onset pre-eclampsia in women with antiphospholipid antibodies: the FRUIT-RCT. Eur J Obstet Gynecol Reprod Biol 2016; 197: 168-73.
DOI: https://doi.org/10.1016/j.ejogrb.2015.12.011
Naru T, Khan RS, Ali R. Pregnancy outcome in women with antiphospholipid syndrome on low-dose aspirin and heparin: a retrospective study. East Mediterr Health J 2010; 16: 308-12.
DOI: https://doi.org/10.26719/2010.16.3.308
Brewster JA, Shaw NJ, Farquharson RG. Neonatal and pediatric outcome of infants born to mothers with antiphospholipid syndrome. J Perinat Med 1999; 27: 183-7.
DOI: https://doi.org/10.1515/JPM.1999.025
Cohn DM, Goddijn M, Middeldorp S, Korevaar JC, Dawood F, Farquharson RG. Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy. J Thromb Haemost 2010; 8: 2208-13.
DOI: https://doi.org/10.1111/j.1538-7836.2010.04015.x
Clark CA, Spitzer KA, Crowther MA, Nadler JN, Laskin MD, Waks JA, Laskin CA. Incidence of postpartum thrombosis and preterm delivery in women with antiphospholipid antibodies and recurrent pregnancy loss. J Rheumatol 2007; 34: 992-6.
Branch DW, Peaceman AM, Druzin M, Silver RK, El-Sayed Y, Silver RM, et al. A multicenter, placebo-controlled pilot study of intravenous immune globulin treatment of antiphospholipid syndrome during pregnancy. The pregnancy loss study group. Am J Obstet Gynecol 2000; 182: 122-7.
DOI: https://doi.org/10.1016/S0002-9378(00)70500-X
Triolo G, Ferrante A, Ciccia F, Accardo-Palumbo A, Perino A, Castelli A, et al. Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies. Arthritis Rheum 2003; 48: 728-31.
DOI: https://doi.org/10.1002/art.10957
Jeremic K, Pervulov M, Gojnic M, Dukanac J, Ljubic A, Stojnic J. Comparison of two therapeutic protocols in patients with antiphospholipid antibodies and recurrent miscarriages. Vojnosanit Pregl 2005; 62: 435-9.
DOI: https://doi.org/10.2298/VSP0506435J
Deguchi M, Yamada H, Sugiura-Ogasawara M, Morikawa M, Fujita D, Miki A, et al. Factors associated with adverse pregnancy outcomes in women with antiphospholipid syndrome: a multicenter study. J Reprod Immunol 2017; 122: 21-7.
DOI: https://doi.org/10.1016/j.jri.2017.08.001
Ruffatti A, Salvan E, Del Ross T, Gerosa M, Andreoli L, Maina A, et al. Treatment strategies and pregnancy outcomes in antiphospholipid syndrome patients with thrombosis and triple antiphospholipid positivity. A European multicentre retrospective study. Thromb Haemost 2014; 112: 727-35.
DOI: https://doi.org/10.1160/TH14-03-0191
Lima F, Khamashta MA, Buchanan NM, Kerslake S, Hunt BJ, Hughes GR. A study of sixty pregnancies in patients with the antiphospholipid syndrome. Clin Exp Rheumatol 1996; 14: 131-6.
Ye SL, Gu XK, Tao LY, Cong JM, Wang YQ. Efficacy of different treatment regimens for antiphospholipid syndrome-related recurrent spontaneous abortion. Chin Med J 2017; 130: 1395-9.
DOI: https://doi.org/10.4103/0366-6999.207471
Tektonidou MG, Andreoli L, Limper M, Amoura Z, Cervera R, Costedoat-Chalumeau N, et al. EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 2019; 78: 1296-304.
DOI: https://doi.org/10.1136/annrheumdis-2019-215213
Buchanan NM, Toubi E, Khamashta MA, Lima F, Kerslake S, Hughes GR. Hydroxychloroquine and lupus pregnancy: review of a series of 36 cases. Ann Rheum Dis 1996; 55: 486-8.
DOI: https://doi.org/10.1136/ard.55.7.486
Clowse ME, Magder L, Witter F, Petri M. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum 2006; 54: 3640-7.
DOI: https://doi.org/10.1002/art.22159
Tani C, Zucchi D, Haase I, Gerosa M, Larosa M, Cavagna L, et al. Impact of low-dose acetylsalicylic acid on pregnancy outcome in systemic lupus erythematosus: results from a multicentre study. Lupus Sci Med 2022; 9: e000714.
DOI: https://doi.org/10.1136/lupus-2022-000714
Bullo M, Tschumi S, Bucher BS, Bianchetti MG, Simonetti GD. Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists: a systematic review. Hypertension 2012; 60: 444-50.
DOI: https://doi.org/10.1161/HYPERTENSIONAHA.112.196352
Buawangpong N, Teekachunhatean S, Koonrungsesomboon N. Adverse pregnancy outcomes associated with first-trimester exposure to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers: a systematic review and meta-analysis. Pharmacol Res Perspect 2020; 8: e00644.
DOI: https://doi.org/10.1002/prp2.644
Soares PM, Borba EF, Bonfa E, Hallak J, Correa AL, Silva CA. Gonad evaluation in male systemic lupus erythematosus. Arthritis Rheum 2007; 56: 2352-61.
DOI: https://doi.org/10.1002/art.22660
Mouyis M, Flint JD, Giles IP. Safety of anti-rheumatic drugs in men trying to conceive: a systematic review and analysis of published evidence. Semin Arthritis Rheum 2019; 48: 911-20.
DOI: https://doi.org/10.1016/j.semarthrit.2018.07.011
Bermas BL. Paternal safety of anti-rheumatic medications. Best Pract Res Clin Obstet Gynaecol 2020; 64: 77-84.
DOI: https://doi.org/10.1016/j.bpobgyn.2019.09.004
Perez-Garcia LF, Dolhain R, Vorstenbosch S, Bramer W, van Puijenbroek E, Hazes JMW, Te Winkel B. The effect of paternal exposure to immunosuppressive drugs on sexual function, reproductive hormones, fertility, pregnancy and offspring outcomes: a systematic review. Hum Reprod Update 2020; 26: 961-1001.
DOI: https://doi.org/10.1093/humupd/dmaa022
Gallo G MR, Ros E, Filia A. Guida alle controindicazioni alle vaccinazioni (aggiornamento 2018). Rapporti ISTISAN 19/3. Istituto Superiore Di Sanità. 2019. Available from: https://www.sitip.org/images/linee-guida/AA_Versione_ISTISAN_2018.pdf.
Palmsten K, Bandoli G, Watkins J, Vazquez-Benitez G, Gilmer TP, Chambers CD. Oral corticosteroids and risk of preterm birth in the california medicaid program. J Allergy Clin Immunol Pract 2021; 9: 375-84.e5.
DOI: https://doi.org/10.1016/j.jaip.2020.07.047
Ostensen M, Matheson I, Laufen H. Piroxicam in breast milk after long-term treatment. Eur J Clin Pharmacol 1988; 35: 567-9.
DOI: https://doi.org/10.1007/BF00558255
Motta M, Tincani A, Faden D, Zinzini E, Lojacono A, Marchesi A, et al. Follow-up of infants exposed to hydroxychloroquine given to mothers during pregnancy and lactation. J Perinatol 2005; 25: 86-9.
DOI: https://doi.org/10.1038/sj.jp.7211208
LactMed®. Drug and lactation database. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/.
Hale TW. Maternal medications during breastfeeding. Clin Obstet Gynecol 2004; 47: 696-711.
DOI: https://doi.org/10.1097/01.grf.0000135653.56778.3f
Ughi N, Padoan R, Crotti C, Sciascia S, Carrara G, Zanetti A, et al. The Italian Society of Rheumatology clinical practice guidelines for the management of large vessel vasculitis. Reumatismo 2022; 73: 1470.
DOI: https://doi.org/10.4081/reumatismo.2021.1470
How to Cite
Crotti, C., Ughi, N., Beretta, E., Brucato, A. L., Carrara, G., Chimenti, M. S., … Tincani, A. (2025). The Italian Society for Rheumatology guidelines on reproductive health in patients with rheumatic diseases. Reumatismo. https://doi.org/10.4081/reumatismo.2025.1752
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