Servicio de Dermatología, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, España.
Servicio de Dermatología, Hospital Universitario Arnau de Vilanova, Valencia, España.
Actas Dermosifiliogr (Engl Ed). 2021 Mar;112(3):225-241. doi: 10.1016/j.ad.2020.10.002. Epub 2020 Oct 13.
To develop evidence- and experience-based recommendations for the management of psoriasis during preconception, pregnancy, postpartum, and breastfeeding.
The nominal group technique and the Delphi method were used. Fifteen experts (12 dermatologists, 2 of whom were appointed coordinators; 1 rheumatologist; and 2 gynecologists) were selected to form an expert panel. Following a systematic review of the literature on fertility, pregnancy, postpartum, and breastfeeding in women with psoriasis, the coordinators drew up a series of preliminary recommendations for discussion by the panel at a nominal group meeting. The experts defined the scope, sections, and intended users of the statement and prepared a final list of recommendations. Consensus was obtained using a Delphi process in which an additional 51 dermatologists rated their level of agreement with each recommendation on a scale of 1 (total disagreement) to 10 (total agreement). Consensus was defined by a score of 7 or higher assigned by at least 70% of participants. Level of evidence and strength of recommendation were reported using the Oxford Center for Evidence-Based Medicine categories. The final statement was approved by the expert panel.
The resulting consensus statement includes 23 recommendations on preconception (fertility and contraception), pregnancy (planning, pharmacological management, and follow-up), and breastfeeding (management and follow-up). Consensus was achieved for all recommendations generated except one.
These recommendations for the better management of psoriasis in women of childbearing age could improve outcomes and prognosis.
针对银屑病患者备孕、妊娠、产后和哺乳期的管理，制定基于证据和经验的推荐意见。
采用名义群体技术和德尔菲法。选择 15 名专家（12 名皮肤科医生，其中 2 名为协调员；1 名风湿病学家；2 名妇科医生）组成专家小组。在对银屑病女性生育力、妊娠、产后和哺乳期的文献进行系统回顾后，协调员在名义群体会议上对一系列初步建议进行了讨论。专家们定义了陈述的范围、章节和预期用户，并准备了最终的推荐清单。通过德尔菲法获得共识，另外 51 名皮肤科医生对每个建议的同意程度进行了 1（完全不同意）到 10（完全同意）的评分。至少 70%的参与者给予 7 分或更高的评分则被认为达成共识。使用牛津循证医学中心的类别报告证据水平和推荐强度。最终的声明得到了专家小组的认可。
产生的共识声明包括 23 条关于备孕（生育力和避孕）、妊娠（计划、药物治疗和随访）和哺乳期（管理和随访）的建议。除了一条建议外，其他所有建议都达成了共识。
这些针对生育期女性银屑病更好管理的建议可以改善结局和预后。
