American College of Rheumatology Prepares Guideline on Reproductive Health in Rheumatic Disease

At its annual meeting, the American College of Rheumatology (ACR) presented a draft of a clinical practice guideline to help rheumatologists and obstetricians/gynecologists manage the reproductive health of patients with rheumatic disease.

According to ACR, the guideline, known as the Reproductive Health in Rheumatic Diseases Guideline, is the first evidence-based clinical practice guideline related to the management of all reproductive health issues for patients across the spectrum of rheumatic diseases.

Lisa R. Sammaritano, MD, of Hospital for Special Surgery–Weill Cornell Medicine in New York, N.Y., and one of the experts involved in the guideline’s development, said that managing pregnancy, especially in women with conditions such as lupus or antiphospholipid antibody syndrome, can be challenging.

“Our patients have particular needs and challenges during pregnancy, and the obstetrician/gynecologist may not always be aware of these,” said Dr. Sammaritano. “In addition, rheumatologists may not be aware of updates in contraception, fertility therapies, and pregnancy management. With the expansion of new therapies available for rheumatic diseases in recent years, especially in rheumatoid arthritis, we need to learn more about which of these new treatments are compatible with pregnancy.”

Some of the important considerations in the reproductive health of patients with rheumatic disease are:

• planning pregnancies ahead of time
• conceiving during periods of low disease activity
• conceiving when neither the mother nor father are using teratogenic medications, which could put a fetus at risk

In preparing the guideline, the panel of experts met with a panel of patients who stressed that “they wanted to talk with their rheumatologist about family planning, early and often,” according to Dr. Sammaritano. In fact, patients often seek guidance from their rheumatologists about safe contraception, fertility issues, and safe medication use during pregnancy and breastfeeding. This guideline will help rheumatologists when their patients ask these important questions about family planning.

To develop the guideline, a panel of rheumatologists, obstetricians/gynecologists, reproductive medicine specialists, epidemiologists, and patients with rheumatic diseases conducted a systematic review of current, evidence-based literature on all aspects of reproductive health in rheumatic disease. They applied standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to assess the quality of the evidence.

ACR plans three papers on the following topics once the guideline is complete:

1. Reproductive health in general, including contraception, assisted reproductive technology, preservation of fertility for women using cytotoxic medications, and menopause, including estrogen replacement therapy
2. Pregnancy counseling and management
3. Medication management for men and women