Table 2 Recommendations of different guidelines for pregnancy management
Guideline | HCQ | Fetal ultrasound echocardiography | Dexamethasone |
|---|---|---|---|
2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases [34] | Conditionally recommend treatment with HCQ during pregnancy | If no prior history of neonatal lupus, serial (interval uncertain) fetal echocardiography in weeks 16–26 If prior history of neonatal lupus, weekly fetal echocardiography in weeks 16–26 | Abnormal fetal echocardiography: If first- or second-degree heart block, treat with dexamethasone 4 mg daily If isolated third-degree heart block (and no other cardiac inflammation), do not treat with dexamethasone |
2017 The British Society for Rheumatology guideline for the management of adults with primary Sjogren’s syndrome [47] | HCQ may be continued throughout pregnancy and breastfeeding HCQ up to a maximum dose of 6 mg/kg is recommended for patients with pSS, especially those with skin and joint disease and fatigue. Patients should be monitored for evidence of a clinical and/or biological response (e.g., falling immunoglobulin levels) If no response after 12 months, consider stopping treatment | Monitor closely with serial ultrasound if anti-Ro and/or anti-La positive and consider referral to specialist center | / |
2016 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 [48] | / | Fetal echocardiography is recommended in cases of suspected fetal dysrhythmia or myocarditis, especially in patients with positive anti-Ro/SSA and/or anti-La/SSB antibodies | / |