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Table 1 Brazilian recommendations for the gynecological and obstetric care of women of Sjogren Syndrome

From: 2021 recommendations of the Brazilian Society of Rheumatology for the gynecological and obstetric care of patients with Sjogren’s syndrome

1

Active inquiry regarding genital and sexual complaints is recommended, since they are not spontaneously reported to the rheumatologist. (hundred percent agreement)

2

Patients should be referred for follow-up with the gynecologist (hundred percent agreement)

3

All pregnant women with SS should be assisted by a multidisciplinary team in a high-risk prenatal care center, regardless of the literature data on gestational outcomes such as spontaneous abortion rates, fetal growth restriction or prematurity (hundred percent agreement)

4

It is recommended that the disease be well controlled in the 6 months before pregnancy and that the profile of antiphospholipid and anti-SSA/Ro antibodies be updated. (hundred percent agreement)

5

Adjustment of pregnancy compatible drugs and specific vitamin supplements for pregnant women are recommended. The use of hydroxychloroquine should be encouraged in positive anti-SSA/Ro pregnant women and it is mandatory in pregnant women with a previous history of fetal heart block or other forms of neonatal lupus (hundred percent agreement)

6

Prenatal care and delivery should be accomplished in a referral hospital (hundred percent agreement)

7

Hydroxychloroquine (5 mg/kg/d) should be prescribed for all positive anti SSA/Ro pregnant women because of its impact on reducing the recurrence of NLS (which can reach 20%) in subsequent pregnancies, compared to patients who do not use the drug (hundred percent agreement)

8

In these pregnant women, the effectiveness of treatment with corticosteroids, human immunoglobulin, β-sympathomimetics, or plasmapheresis is controversial. Dexamethasone may be useful in reversing carditis and incomplete blocks in addition to improving the hemodynamic conditions of the fetus. It is recommended that the decision for treatment be shared and adjusted considering each case (hundred percent agreement)

9

Electrocardiogram and weekly fetal echocardiography are recommended in the interval of greatest risk for the onset of heart block (CHB) and in the newborn (12–22 weeks) (hundred percent agreement)

10

All newborns should also be evaluated with a blood count and liver assessment. The risk of these children developing an autoimmune disease in the future is not increased (hundred percent agreement)

11

Breastfeeding should be encouraged (hundred percent agreement)