Clinical Management Guidelines for Friedreich Ataxia (FRDA)

Chapter 13. Family planning and pregnancy in Friedreich ataxia

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This chapter of the Clinical Management Guidelines for Friedreich Ataxia and the recommendations and best practice statements contained herein were endorsed by the authors and the Friedreich Ataxia Guidelines Panel in 2022.

13.1 Overview of family planning and pregnancy issues in Friedreich ataxia

13.2 Planning for pregnancy

13.3 Cardiac considerations for women planning for pregnancy

13.4 Management during pregnancy and delivery

13.5 Management during the post-partum period

Disclaimer / Intended Use / Funding

Disclaimer
The Clinical Management Guidelines for Friedreich ataxia (‘Guidelines’) are protected by copyright owned by the authors who contributed to their development or said authors’ assignees.

These Guidelines are systematically developed evidence statements incorporating data from a comprehensive literature review of the most recent studies available (up to the Guidelines submission date) and reviewed according to the Grading of Recommendations, Assessment Development and Evaluations (GRADE) framework © The Grade Working Group.

Guidelines users must seek out the most recent information that might supersede the diagnostic and treatment recommendations contained within these Guidelines and consider local variations in clinical settings, funding and resources that may impact on the implementation of the recommendations set out in these Guidelines.

The authors of these Guidelines disclaim all liability for the accuracy or completeness of the Guidelines, and disclaim all warranties, express or implied to their incorrect use.

Intended Use
These Guidelines are made available as general information only and do not constitute medical advice. These Guidelines are intended to assist qualified healthcare professionals make informed treatment decisions about the care of individuals with Friedreich ataxia. They are not intended as a sole source of guidance in managing issues related to Friedreich ataxia. Rather, they are designed to assist clinicians by providing an evidence-based framework for decision-making.

These Guidelines are not intended to replace clinical judgment and other approaches to diagnosing and managing problems associated with Friedreich ataxia which may be appropriate in specific circumstances. Ultimately, healthcare professionals must make their own treatment decisions on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge and expertise.
Guidelines users must not edit or modify the Guidelines in any way – including removing any branding, acknowledgement, authorship or copyright notice.

Funding
The authors of this document gratefully acknowledge the support of the Friedreich Ataxia Research Alliance (FARA). The views and opinions expressed in the Guidelines are solely those of the authors and do not necessarily reflect the official policy or position of FARA.


13. Family planning and pregnancy in Friedreich ataxia

Lisa Friedman, Kimberly Schadt and David Lynch are acknowledged for much of the content of this chapter, taken from the previous version of the guidelines (2014).

Roger Peverill and Aarti Patel prepared the updated section on cardiac considerations and the corresponding recommendation (section 13.3).

This chapter covers the management of couples contemplating pregnancy and the prenatal and postnatal care of women with Friedreich ataxia, including the delivery of the baby and care following birth. This chapter largely comprises material from the 2014 guidelines, with the exception of the material related to cardiac considerations (section 13.3). In writing best practice statements and recommendations, the authors were tasked with answering the following questions:

For individuals with Friedreich ataxia what is the best management for pre-pregnancy counselling and family planning considerations? (see 13.2)

For women with Friedreich ataxia with heart failure what is the best management before and during pregnancy? (see 13.3)

For women with Friedreich ataxia what is the best management during pregnancy? (see 13.4)

For women with Friedreich ataxia what is the best management for other complications (besides heart failure) during pregnancy? (see 13.4)

For women with Friedreich ataxia what is the best management during delivery? (see 13.4)

For women with Friedreich ataxia what is the best management if anaesthesia is required during delivery? (see 13.4)

For women with Friedreich ataxia what is the best management during the post-partum period? (see 13.5)

Lisa Friedman, Kimberly Schadt and David Lynch are acknowledged for much of the content of this chapter, taken from the previous version of the guidelines (2014).

Roger Peverill and Aarti Patel prepared the updated section on cardiac considerations and the corresponding recommendation (section 13.3).

Aarti Patel, MD
Associate Professor of Medicine, University of South Florida, Tampa, Florida, USA
Email: apatel15@usf.edu

Roger E. Peverill, MBBS, PhD
Cardiologist, MonashHeart, Monash Health, Clayton, Victoria, Australia
Email: roger.peverill@monash.edu

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19. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Intrapartum fetal surveillance. Clinical guidelines – fourth edition. www.ranzcog.edu.au: RANZCOG; 2019.

These Guidelines are systematically developed evidence statements incorporating data from a comprehensive literature review of the most recent studies available (up to the Guidelines submission date) and reviewed according to the Grading of Recommendations, Assessment Development and Evaluations (GRADE) framework © The Grade Working Group.

This chapter of the Clinical Management Guidelines for Friedreich Ataxia and the recommendations and best practice statements contained herein were endorsed by the authors and the Friedreich Ataxia Guidelines Panel in 2022.

It is our expectation that going forward individual topics can be updated in real-time in response to new evidence versus a re-evaluation and update of all topics simultaneously.