**4.2 EULAR 2020 consensus-based core set data for pregnancy in SLE**

In an effort to increase knowledge about pregnancy course and safety of treatment in women with immune mediated rheumatic disorders, *European League Against Rheumatology* published in 2020 its first consensus-based core data set for prospective pregnancy registries in rheumatology [5].

The *EULAR Task Force* recommended disease-specific items, autoantibodies/ laboratory markers and disease activity measurements relevant for different IMRDs including SLE. aPL antibodies, particularly anti-cardiolipin, and anti-beta-2-glycoprotein-I antibodies as well as lupus anticoagulant; antinuclear and anti-dsDNA

**Figure 2.** *EULAR core set data for pregnancy in rheumatology (adapted [5]).*

*Challenges in the Delivery Room: Integrated Analysis of Biomarkers Predicting Complications… DOI: http://dx.doi.org/10.5772/intechopen.96099*

#### **Figure 3.**

*Proposed core-set data for the midwifery room (adapted from EULAR 2020) [5].*

antibodies, extractable nuclear antigen antibodies such as anti-Ro/La, anti-Sm and anti-U1-ribonucleoprotein, but also serum C3 and C4 levels should be collected as recommended by EULAR, while follow-up indexes include SLEPDAI and SLICC/ ACR damage index [4, 5, 18].

EULAR endorsed three core set data on clinically relevant parameters - maternal information, pregnancy and treatment [1–3, 5, 21] (**Figure 2**); *maternal information* refers to demographics and risk behaviors, disease characteristics of the underlying SLE and prevalent comorbidities; *pregnancy* data covers obstetrical history, the course, outcomes and delivery of previous and current pregnancy and outcomes of the neonate, while *treatment* domain encompasses for medical treatment within 12 months prior to conception, SLE treatment during pregnancy and postpartum [1–5, 21].

A comprehensive/extensive list of items were considered the most relevant items regarding maternal information and the rheumatic disease as well as pregnancy and neonatal outcomes (**Figure 3**) and should be collected uniformly [1, 3–5, 21].

EULAR endorsed recommendations focused on the time of pregnancy and the 28-day postpartum period (neonatal phase); as the core set represents clinically relevant and feasible parameters, it should be collected once every trimester for the maternal and new-born health evaluation [1, 3, 5, 21].

Besides, as addressing the most important information needed to answer questions about disease activity, medication use and pregnancy outcome, EULAR parameters should be extrapolated, at least in part, for the assessment in daily practice; this will clearly be of help in the midwifery room [1, 3, 5, 21].

#### **5. Conclusion**

Reproductive health in SLE remains an important topic as maternal complications and adverse fetal outcomes in lupus still exceed the rate of pregnancy complications in general population. Clinical or subclinical inflammation, autoantibodies, hormonal dysfunction and specific immune alterations of lupus may contribute to pregnancy complications.

Thus, SLE and pregnancy is definitely associated with an increased need for investigations (repeated ultrasound, tests for fetal well-being, predictive biomarkers for pregnancy outcomes) as well as prolonged hospitalization, promoting high prenatal and neonatal burden.

Several biomarkers have been already investigated in early pregnancy and we are now able to predict complications in SLE suggesting that both preconception and follow-up assessments are mandatory to risk-stratify patients and to identity predictors for adverse pregnancy outcomes.

Although pivotal studies have demonstrated a greater rate of caesarian section among lupus pregnancy than in general population, vaginal delivery still remains an option and adequate pelvic assessment should always be performed by midwifes in order to ensure best delivery outcomes.

Moreover, midwifes help our researchers to discover valuable information in an effort of better understand the mechanisms involved in the disease. On the other hand, there is a lack of full understanding of what the researchers in our hospitals are doing, as every researcher and midwife should be allowed to examine patients for any possible medical signs and symptoms and to determine the general status during pregnancy.

This chapter is intended to be a state-of-the-art manuscript focused on improving health-care for pregnant women with SLE.
