**4.1 ACR recommendations for reproductive health-care in SLE**

In 2020, *American College of Rheumatology* (ACR) releases an updated guideline with recommendations for reproductive health-care in rheumatic diseases, particularly SLE with and without anti-Ro/La and aPL antibodies [6].

Hereby we summarized the most important statements regarding pregnancy counseling, assessment and monitoring to improve maternal and fetal outcomes in SLE women (**Figure 1**) [6]**:**


#### **Figure 1.**

*Pregnancy counseling, assessment and management in woman with SLE (ACR2020 adapted) [6]. \*If on; \*\*if not a contraindication; NLE, neonatal lupus; HB, heart block; CBH, complete heart block.*

persistence of unchanged titers of these antibodies, ACR strongly recommend *against* repeating the test during pregnancy. Besides, it is also strongly recommend testing for aPL before or early in pregnancy, while repeating these tests during pregnancy is not necessary [6];

