The Asia Pacific League of Associations for Rheumatology (APLAR) Consensus Statements for the Management of Reproductive Issues in Autoimmune Rheumatic Diseases

Abstract

Background: The management of reproductive health in individuals with autoimmune rheumatic diseases (AIRDs) has evolved into a primary clinical priority. Wide variations in clinical practice and drug availability in the Asia-Pacific regions necessitate localized frameworks. These consensus statements, developed by the Asia Pacific League of Associations for Rheumatology (APLAR) Special Interest Group for Women's Health & Reproductive Issues in Rheumatic and Musculoskeletal Diseases, aim to bridge the gaps within the region, foster multidisciplinary collaboration, and address regional knowledge deficits. Methods: An expert panel comprising 16 members of the 13 APLAR member nation organizations formulated 23 research questions using the PICO framework. A systematic review of English-language literature up to July 2025 was conducted across the MEDLINE, Scopus, Google Scholar, and Cochrane Library databases, supplemented by a manual search of journals from the APLAR regions. Evidence from the APLAR region was appraised using the GRADE system. A modified Delphi online voting process was employed to reach consensus, pre-defined as ≥ 75% agreement. Results: The panel approved four overarching principles and 86 statements, organized into 16 broad categories. These statements cover all three phases of pregnancy in AIRDs, the safety of medications during pregnancy and lactation, contraception, assisted reproductive techniques, fertility preservation, and hormonal replacement therapy, covering both female and male aspects as relevant. Conclusion: In a field often lacking high-quality data, these consensus statements from APLAR provide expert opinion-based guidance to support clinical decision-making. It is envisaged that it will assist in educational and training purposes and help shape future research priorities.