Table 2.

Recommendations of different guidelines for pregnancy management

Guideline	HCQ	Fetal ultrasound echocardiography	Dexamethasone
2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases [34]	Conditionally recommend treatment with HCQ during pregnancy	If no prior history of neonatal lupus, serial (interval uncertain) fetal echocardiography in weeks 16–26 If prior history of neonatal lupus, weekly fetal echocardiography in weeks 16–26	Abnormal fetal echocardiography: If first- or second-degree heart block, treat with dexamethasone 4 mg daily If isolated third-degree heart block (and no other cardiac inflammation), do not treat with dexamethasone
2017 The British Society for Rheumatology guideline for the management of adults with primary Sjogren’s syndrome [47]	HCQ may be continued throughout pregnancy and breastfeeding HCQ up to a maximum dose of 6 mg/kg is recommended for patients with pSS, especially those with skin and joint disease and fatigue. Patients should be monitored for evidence of a clinical and/or biological response (e.g., falling immunoglobulin levels) If no response after 12 months, consider stopping treatment	Monitor closely with serial ultrasound if anti-Ro and/or anti-La positive and consider referral to specialist center	/
2016 EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome [48]	/	Fetal echocardiography is recommended in cases of suspected fetal dysrhythmia or myocarditis, especially in patients with positive anti-Ro/SSA and/or anti-La/SSB antibodies	/