1
|
Abstract
ABSTRACT Contraception can help individuals with rheumatic and musculoskeletal diseases (RMDs) to avoid undesired pregnancies and improve reproductive outcomes. Despite the importance of contraception in the care of females with RMDs, evidence suggests that many of these individuals do not receive consistent or disease-specific counseling regarding contraceptive options. This includes female patients receiving teratogenic prescriptions as part of the management of their RMDs, or who have severe disease activity that might culminate in adverse pregnancy and perinatal outcomes. Contraceptive counseling can help females with RMDs who wish to prevent pregnancy to select a contraceptive method that is best for them.We conducted a narrative review of the primary literature addressing reversible, prescription-based contraception for females with RMDs, framed by published guidelines on contraceptive safety. Many safe and effective contraceptive options are available for females with RMDs. Special considerations must be given to individuals with systemic lupus erythematosus, whose disease activity may be exacerbated by exogenous estrogen. Females with positive antiphospholipid antibodies should avoid estrogen-containing contraception due to an unacceptable risk of thrombosis and should conditionally avoid depot medroxyprogesterone acetate, which appears to have a prothrombotic signature. Limited contraceptive options are available to male patients. Contraceptive care for adolescents with RMDs can be extrapolated from guidelines written for adult patients, with the additional consideration of barrier protection for individuals at risk for sexually transmitted infections. Future research is needed to assess the effects of contraception use on rheumatic disease activity and side effects.
Collapse
Affiliation(s)
- Nicole Luche
- From the Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Mehret Birru Talabi
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
2
|
Clowse MEB, Li J, Snyderman A, Schmajuk G. Alignment of contraception use with the ACR reproductive health guidelines in women with systemic lupus erythematosus within the RISE registry. Lupus Sci Med 2024; 11:e001192. [PMID: 39181689 PMCID: PMC11344492 DOI: 10.1136/lupus-2024-001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/27/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES Contraception is crucial for safely timing pregnancies in patients with SLE. This study investigated predictors of contraception documentation in patients with SLE, and the alignment of contraception practices with the 2020 American College of Rheumatology (ACR) guidelines, within the Rheumatology Informatics System for Effectiveness (RISE) registry. MATERIALS AND METHODS Female patients (aged 18-44 years) with SLE were identified via International Classification of Diseases (ICD)-9/ICD-10 coding within the RISE registry, which includes data from rheumatology clinics across the USA. Eligible patients were required to have ≥1 clinical visit in 2019 (prepandemic) or between 1 April 2020 and 30 March 2021 (mid-pandemic). Adjusted multilevel logistic modelling assessed patient, provider and practice characteristics for associations with contraception documentation. Contraception patterns were identified and compared with the 2020 ACR guidelines. RESULTS Contraception documentation rates were similar in the prepandemic and mid-pandemic groups (8.1% and 8.5%, respectively). Higher documentation rates were found in women who were younger, White, and had more visits, as well as those seen within a health system, by a female provider, and within specific regions and electronic health record (EHR) systems. Prescription of a teratogenic medication did not influence contraception documentation or type. Oestrogen-containing contraceptives were prescribed less often to women at high risk for thrombosis (26.2% with thrombotic risk vs 60.6% without, p<0.0001) and history of lupus nephritis (LN) (53.8% with history of LN vs 63.2% without, p=0.024). CONCLUSIONS Practices participating in the RISE registry do not currently record contraception in the large majority of women with SLE, although increased documentation in some EHRs suggests that system changes may improve rates of documentation. Women at higher risk for thrombosis were less likely to receive oestrogen, suggesting that warnings against oestrogen use has impacted contraception prescription, although the limited documentation and limited contraception among women taking teratogenic medications suggest a high unmet need.
Collapse
Affiliation(s)
- Megan E B Clowse
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jing Li
- Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Amanda Snyderman
- Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gabriela Schmajuk
- Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
3
|
Bridges JM, Li J, Mannion ML, Clowse MEB, Schmajuk G, Singh JA. Contraception Care Patterns for Adult Females With Juvenile Idiopathic Arthritis on Teratogens in the Rheumatology Informatics System for Effectiveness (RISE) Registry. J Rheumatol 2024; 51:542-545. [PMID: 38224995 DOI: 10.3899/jrheum.2023-1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- John M Bridges
- University of Alabama at Birmingham, Birmingham, Alabama;
| | - Jing Li
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California
| | | | - Megan E B Clowse
- Duke University, Division of Rheumatology and Immunology, Durham, North Carolina
| | - Gabriela Schmajuk
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California
- Philip R. Lee Institute for Health Policy Research, Department of Medicine, University of California San Francisco, San Francisco, California
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, Alabama
- Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), and Department of Epidemiology at the UAB School of Public Health, Birmingham, Alabama, USA
| |
Collapse
|
4
|
Clowse MEB, Li J, Talabi MB, Eudy AM, Schmajuk G. Frequency of Contraception Documentation in Women With Systemic Lupus Erythematosus and Rheumatoid Arthritis Within the Rheumatology Informatics System for Effectiveness Registry. Arthritis Care Res (Hoboken) 2023; 75:590-596. [PMID: 34623033 PMCID: PMC8989718 DOI: 10.1002/acr.24803] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/19/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We sought to understand the frequency of contraception documentation for women with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in a large US electronic health record (EHR)-based registry and to identify disparities by teratogen prescription and patient race and ethnicity. METHODS Contraception documentation from structured data fields within the Rheumatology Informatics System for Effectiveness (RISE) registry was collected for women of childbearing age (18-45 years) in 2018 who had at least 2 visits with International Classification of Diseases, Ninth Revision or Tenth Revision, diagnosis codes for SLE or RA (at any time). Univariate and multivariate analyses compared the frequency of contraception documentation based on patient characteristics including diagnosis, age, race, and teratogenicity of prescribed antirheumatic medications. RESULTS In 2018, there were 9,826 women of childbearing age with SLE and 19,009 with RA, of whom 9.1% had any contraception documented. Rates of contraceptive documentation were significantly lower for women with SLE (adjusted odds ratio [OR] 0.84 [95% confidence interval (95% CI) 0.76-0.92]). Women of Hispanic ethnicity and Black and Asian race were all less likely than White women to have contraception documentation. Teratogen prescription was associated with higher rates of contraception documentation for women with RA but not SLE (RA adjusted OR 1.31 [95% CI 1.16-1.47]; SLE adjusted OR 1.08 [95% CI 0.91-1.28]). CONCLUSION There are large gaps in contraception documentation within the RISE registry that are particularly stark among women of color. Although these data likely underestimate contraception use, they highlight that most rheumatologists do not have a systematic approach to collecting and recording this information in the EHR.
Collapse
Affiliation(s)
| | - Jing Li
- University of California, San Francisco
| | | | | | - Gabriela Schmajuk
- University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center
| |
Collapse
|
5
|
Harris ML, Egan N, Forder PM, Bateson D, Loxton D. Patterns of contraceptive use through later reproductive years: A cohort study of Australian women with chronic disease. PLoS One 2023; 18:e0268872. [PMID: 37134070 PMCID: PMC10155986 DOI: 10.1371/journal.pone.0268872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 04/11/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Pregnancies among women with chronic disease are associated with poor maternal and fetal outcomes. There is a need to understand how women use or don't use contraception across their reproductive years to better inform the development of preconception care strategies to reduce high risk unintended pregnancies, including among women of older reproductive age. However, there is a lack of high-quality longitudinal evidence to inform such strategies. We examined patterns of contraceptive use among a population-based cohort of reproductive aged women and investigated how chronic disease influenced contraceptive use over time. METHODS AND FINDINGS Contraceptive patterns from 8,030 women of reproductive age from the Australian Longitudinal Study on Women's Health (1973-78 cohort), who were at potential risk of an unintended pregnancy were identified using latent transition analysis. Multinomial mixed-effect logistic regression models were used to evaluate the relationship between contraceptive combinations and chronic disease. Contraception non-use increased between 2006 and 2018 but was similar between women with and without chronic disease (13.6% vs. 12.7% among women aged 40-45 years in 2018). When specific contraceptive use patterns were examined over time, differences were found for women with autoinflammatory diseases only. These women had increased odds of using condom and natural methods (OR = 1.20, 95% CI = 1.00, 1.44), and sterilisation and other methods (OR = 1.61, 95% CI = 1.08, 2.39) or no contraception (OR = 1.32, 95% CI = 1.04, 1.66), compared to women without chronic disease using short-acting methods and condoms. CONCLUSION Potential gaps in the provision of appropriate contraceptive access and care exist for women with chronic disease, particularly for women diagnosed with autoinflammatory conditions. Development of national guidelines as well as a clear coordinated contraceptive strategy that begins in adolescence and is regularly reviewed during care management through their main reproductive years and into perimenopause is required to increase support for, and agency among, women with chronic disease.
Collapse
Affiliation(s)
- Melissa L Harris
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Nicholas Egan
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Peta M Forder
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Deborah Bateson
- Family Planning NSW, Ashfield, New South Wales, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Deborah Loxton
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| |
Collapse
|
6
|
Edens C. The Impact of Pediatric Rheumatic Diseases on Sexual Health, Family Planning, and Pregnancy. Rheum Dis Clin North Am 2021; 48:113-140. [PMID: 34798942 DOI: 10.1016/j.rdc.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A comprehensive review of reproductive health subtopics, including sexual intercourse, romantic relationships, contraception, sexually transmitted infections, pregnancy, and infertility, as they pertain to patients with pediatric rheumatic diseases and those who care for them.
Collapse
Affiliation(s)
- Cuoghi Edens
- Department of Pediatrics, Section of Pediatric Rheumatology, University of Chicago Medicine, 5841 South Maryland Avenue, C104-A, MC5044, Chicago, IL 60637, USA; Department of Internal Medicine, Section of Rheumatology, University of Chicago Medicine, 5841 South Maryland Avenue, C104-A, MC5044, Chicago, IL 60637, USA.
| |
Collapse
|
7
|
Williams JN, Xu C, Costenbader KH, Bermas BL, Pace LE, Feldman CH. Racial Differences in Contraception Encounters and Dispensing Among Female Medicaid Beneficiaries With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2021; 73:1396-1404. [PMID: 32526084 PMCID: PMC7728620 DOI: 10.1002/acr.24346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/02/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE African American and Hispanic women with systemic lupus erythematosus (SLE) have the highest rates of potentially avoidable pregnancy complications, yet racial disparities in family planning among reproductive-age women with SLE have not been well-studied. Our objective was to examine whether there are racial differences in contraception encounters and dispensing among US Medicaid-insured women with SLE. METHODS Using Medicaid claims data from 2000-2010, we identified women ages 18-50 years with SLE. We examined contraception encounters and uptake over 24 months. We used multivariable logistic regression to estimate the odds ratio and 95% confidence interval by race/ethnicity of contraception encounters, any contraception dispensing, and highly effective contraception (HEC) use, adjusted for age, region, year, SLE severity, and contraindication to estrogen. We also compared contraception encounters and dispensing among women with SLE to the general population and women with diabetes mellitus. RESULTS We identified 24,693 reproductive-age women with SLE; 43% were African American, 35% White, 15% Hispanic, 4% Asian, 2% other race, and 1% American Indian/Alaska Native. Nine percent had a contraceptive visit, 10% received any contraception, and 2% received HEC. Compared to White women, African American and Asian women had lower odds of contraception dispensing, and African American women had lower odds of HEC use. Women with SLE were more likely to receive HEC than the general population and women with diabetes mellitus. CONCLUSION In this study of reproductive-age women with SLE, African American and Asian women had lower odds of contraception dispensing and African American women had lower odds of HEC use. Further study is needed to understand the factors driving these racial disparities among this population.
Collapse
Affiliation(s)
- Jessica N. Williams
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chang Xu
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen H. Costenbader
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bonnie L. Bermas
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lydia E. Pace
- Division of Women’s Health, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Candace H. Feldman
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
8
|
Wolgemuth T, Stransky OM, Chodoff A, Kazmerski TM, Clowse MEB, Birru Talabi M. Exploring the Preferences of Women Regarding Sexual and Reproductive Health Care in the Context of Rheumatology: A Qualitative Study. Arthritis Care Res (Hoboken) 2021; 73:1194-1200. [PMID: 32374928 DOI: 10.1002/acr.24249] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore the sexual and reproductive health (SRH) care and counseling needs of young women with rheumatic diseases in the context of their rheumatology care. METHODS Semistructured qualitative telephone interviews were conducted with female patients with rheumatic diseases ages 18-45 years (n = 30). Women were recruited from outpatient rheumatology clinics in western Pennsylvania. Interviews were audiorecorded and transcribed verbatim. A codebook was inductively developed based on the interview transcripts, and the finalized coding was used to conduct a thematic analysis. RESULTS Four themes emerged from interviews: 1) women want rheumatologists to initiate conversations about SRH and to revisit the conversation over time; 2) women desire clear and complete information regarding fetal, pregnancy, and infertility risks associated with their diseases and disease-modifying antirheumatic drugs (DMARDs); 3) women want to be treated holistically, with SRH addressed in the context of their life circumstances and personal values in addition to their rheumatic diseases; 4) women generally feel that they are intermediaries between their rheumatologists and obstetrician-gynecologists (OB/GYNs), but preferred for providers to communicate directly with one another about their SRH. CONCLUSION Patients strongly desired rheumatologists to play an active role in their SRH, by initiating family planning conversations, providing SRH education in the context of their diseases and DMARDs, and directly coordinating SRH care with OB/GYNs. To meet patients' SRH needs, further work is needed to clarify the specific role of rheumatologists in providing SRH care and to identify ways to better facilitate communication between rheumatologists and reproductive health care providers.
Collapse
Affiliation(s)
- Tierney Wolgemuth
- Center for Women's Health Research and Innovation and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Olivia M Stransky
- Center for Women's Health Research and Innovation, Pittsburgh, Pennsylvania
| | | | - Traci M Kazmerski
- Center for Women's Health Research and Innovation and University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Mehret Birru Talabi
- Center for Women's Health Research and Innovation and University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
9
|
Sammaritano LR. Which Hormones and Contraception for Women with APS? Exogenous Hormone Use in Women with APS. Curr Rheumatol Rep 2021; 23:44. [PMID: 33939022 DOI: 10.1007/s11926-021-01006-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Use of exogenous estrogen carries significant risk for patients with prothrombotic disorders including those with antiphospholipid antibody (aPL) and antiphospholipid syndrome (APS). This review summarizes current knowledge of contraceptive and other hormone therapies for aPL-positive and APS women and highlights knowledge gaps to guide future research. RECENT FINDINGS Studies support very low risk for most progestin-only contraceptives in patients with increased thrombotic risk, but suggest increased VTE risk with depot-medroxyprogesterone acetate. Highest efficacy contraceptives are intrauterine devices and subdermal implants, and these are recommended for women with aPL/APS. Progestin-only pills are effective and low risk. Perimenopausal symptoms may be treated with nonhormone therapies in aPL/APS patients: vasomotor symptoms can improve with nonhormonal medications and cognitive behavioral therapy, and genitourinary symptoms often improve with intravaginal estrogen that has limited systemic absorption.
Collapse
Affiliation(s)
- Lisa R Sammaritano
- Weill Cornell Medicine, New York, NY, 10021, USA.
- Hospital for Special Surgery, New York, NY, 10021, USA.
| |
Collapse
|
10
|
Ledón-LLanes L, Contreras-Yáñez I, Guaracha-Basáñez G, Valverde-Hernández SS, González-Marín A, Ballinas-Sánchez ÁDJ, Durand M, Pascual-Ramos V. Views of Mexican outpatients with rheumatoid arthritis on sexual and reproductive health: A cross-sectional study. PLoS One 2021; 16:e0245538. [PMID: 33507948 PMCID: PMC7842945 DOI: 10.1371/journal.pone.0245538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/30/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) impacts sexual and reproductive health (SRH), which is a prominent component of a patient´s quality of life and highly influenced by the cultural background. The aim of the study was to explore the interest of Mexican outpatients with RA in SRH and to examine patient view on SRH. METHODS This cross-sectional study surveyed 303 consecutive outpatients with RA on their perceptions of SRH importance, SRH satisfaction, access to SRH information, preferences regarding SRH communication with healthcare professionals, and understanding of SRH (qualitative open-ended descriptions). Descriptive statistics and inferential analysis were used. Patient knowledge of each dimension of SRH was rated based on pre-specified criteria. Two assessors assigned ten major themes to each patient´s description of both dimensions of SRH. RESULTS Patients perceived their SRH as an important component of their general health and wished to address the topic, although few had access to such communication. Female patients assigned lesser importance to SRH, showed lesser degree of satisfaction with SRH, and expressed preference for a truthful physician. Age showed a linear association with individual survey responses, except for satisfaction with reproductive health dimension. There was a linear association between increased age and decreased years of formal education with a lower level of SRH knowledge. Ten major themes emerged for each of the two dimensions of the SRH construct, although most individual descriptions were assigned to one or two major themes. CONCLUSIONS Further education and assessment of SRH in Mexican patients with RA is warranted.
Collapse
Affiliation(s)
- Loraine Ledón-LLanes
- Department of Biology of Reproduction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Guillermo Guaracha-Basáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Salvador Saúl Valverde-Hernández
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anayanci González-Marín
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ángel de Jesús Ballinas-Sánchez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Marta Durand
- Department of Biology of Reproduction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
11
|
Gupta L, Balakrishnan A, Mehta P. Pregnancy counseling in rheumatic diseases: Where science meets the steps. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_79_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Contraception decision-making and care among reproductive-aged women with autoimmune diseases. Contraception 2020; 103:86-91. [PMID: 33181126 DOI: 10.1016/j.contraception.2020.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In this qualitative study, we sought to understand better the contraception-related experiences and decision-making of women with autoimmune diseases, a group at high risk for adverse pregnancy and perinatal outcomes. STUDY DESIGN We conducted semi-structured telephone interviews with women ages 18 to 45 who had at least one autoimmune disease diagnosis. Our team recruited from outpatient rheumatology clinics in Pittsburgh, Pennsylvania. We analyzed our data for content and themes, using inductive and deductive techniques and the constant comparison approach. RESULTS The 30 women in the sample ranged from 25 to 44 years old; most were white (73%), married (52%), and had at least one child (53%). Four themes emerged from our interviews: (1) Women's decisions to use contraception were strongly influenced by their diseases and perceptions of their health; (2) Women felt that hormonal contraception was unsafe in the context of their diseases, even women without clear disease-related health risks; (3) Health care providers influenced women's consideration and selection of contraceptive methods; (4) Women rarely expected that their rheumatologists would prescribe their contraception, yet their contraception prescribers lacked knowledge about their disease-specific health risks. CONCLUSIONS Women perceived that hormonal contraception is unsafe in the context of their autoimmune diseases and cited medication fatigue and safety concerns as reasons why they did not use contraception. Some women did not appear to receive patient-centered contraception counseling from providers. Our interviews reveal areas for improving contraception care, including augmenting shared decision-making and educating patients and providers about contraception safety. IMPLICATIONS Our findings highlight potential tensions between patients' preferences for contraception, safety considerations, and ethical and medically responsible contraception care by health care providers in the rheumatology context. Future work is needed to develop person-centered, medically-appropriate models for contraception care that meet the needs of medically vulnerable populations.
Collapse
|
13
|
Carandang K, Mruk V, Ardoin SP, Huynh B, Clowse MEB, Berlan ED, Edens C. Reproductive health needs of adolescent and young adult women with pediatric rheumatic diseases. Pediatr Rheumatol Online J 2020; 18:66. [PMID: 32807193 PMCID: PMC7433038 DOI: 10.1186/s12969-020-00460-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify reproductive health knowledge gaps and topics that concern adolescent and young adult (AYA) women with pediatric rheumatic diseases and their parents. METHODS Data collection occurred in two cohorts. In the first cohort, young women (15-20 years old) with pediatric-onset rheumatic conditions and their parents were recruited from a single, academic pediatric rheumatology center. In the second cohort, young women (18-25 years old) with pediatric-onset rheumatic conditions were recruited from a national conference for families with pediatric rheumatic diseases. This resulted in 20 adolescents and young adults (18.3 ± 2.4 years old), and 7 parent focus group participants. Focus group leaders facilitated discussions centered on reproductive health topics that participants identified as important, their sources of knowledge, and preferences for patient education and ongoing follow-up. Data were summarized independently by 4 researchers to reduce potential bias and subsequently analyzed using rapid qualitative analysis. RESULTS All participants, regardless of diagnosis, medication, current sexual activity, or current intention to have children, expressed concern about the effect of their rheumatic condition and medications on fertility, risks to mother and child during and after pregnancy, and obtaining safe and effective contraception. Additionally, some participants discussed the burden of disease and its potential impact on motherhood. Finally, participants raised concern around the effect of disease and medication on routine reproductive health care, such as menstrual cycles, feminine self-care, and preventive exams. Three themes emerged: 1) participants had been advised to avoid unplanned pregnancy, however reported receiving inadequate explanation to support this instruction, 2) participants conceptualized reproductive health as tied to rheumatic disease management and thus suggested ways to include family members in discussion, and 3) rheumatology practitioners were not considered a resource of reproductive health information. CONCLUSIONS Young women and their parents reported dissatisfaction with the availability, quantity, and quality of reproductive health information they received, particularly when related to their pediatric-onset rheumatic disease. These findings provide an initial step in understanding the patient perspective of reproductive health in rheumatology, and how to address these concerns in the care of young women with rheumatic diseases.
Collapse
Affiliation(s)
- Kristine Carandang
- Department of Psychiatry, University of California, La Jolla, San Diego, California, USA. .,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, California, 92123, USA.
| | - Veronica Mruk
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, OH USA
| | - Stacy P. Ardoin
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, OH USA
| | - Brittany Huynh
- grid.257413.60000 0001 2287 3919Indiana University School of Medicine, Indianapolis, IN USA
| | - Megan E. B. Clowse
- grid.189509.c0000000100241216Duke University Medical Center, Durham, North Carolina USA
| | - Elise D. Berlan
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, OH USA
| | - Cuoghi Edens
- grid.170205.10000 0004 1936 7822University of Chicago, Chicago, IL USA
| |
Collapse
|
14
|
Skinner-Taylor CM, Perez-Barbosa L, Barriga-Maldonado ES, Cardenas-de la Garza JA, Diaz-Angulo JE, Figueroa-Parra G, Riega-Torres J, Galarza-Delgado DA. Reproductive health counseling and contraceptive use in Mexican women with rheumatic diseases: a cross-sectional study. Rheumatol Int 2020; 41:409-414. [PMID: 32797280 DOI: 10.1007/s00296-020-04679-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is an overall increased risk of adverse pregnancy outcomes and maternal morbidity in patients with most autoimmune rheumatic diseases (ARD); outcomes are generally improved when the pregnancy is planned and the disease is in control. OBJECTIVE The objective of the present study was to describe the sexual and reproductive health characteristics and contraceptive use of Mexican women in childbearing age with ARD. METHODS We conducted an observational, cross-sectional, and descriptive study. All non-pregnant childbearing age women with an ARD were invited to participate. A self-administered questionnaire of ten items that included questions about sexuality, use of contraceptive methods, pregnancy desire, and contraceptional counseling was applied. RESULTS A total of 135 women were evaluated. The median age was 33 (25-39) years. Contraceptive use was referred by 49 (71%) of the patients that had sexual activity the last month, while 20 (28.9%) patients denied use. From the patients who had initiated sexual activity (N = 112), 41 (36.6%) did not use any contraceptive method, and 16 (14%) used a method classified as ineffective. The question about contraceptive counseling was answered by 112 patients. Eighty (70.4%) said they had received counseling from health-professional and 64 (57.1%) from their rheumatologist. A total of 57% of the women with teratogenic drugs did not employ a contraception method. CONCLUSION Contraceptive use and reproductive health counseling are suboptimal in Mexican women with ARD. A high proportion of women taking teratogenic drugs did not employ a highly effective contraceptive method. Strategies to improve reproductive and sexual health are necessary.
Collapse
Affiliation(s)
- Cassandra Michele Skinner-Taylor
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 644600, Monterrey, Mexico
| | - Lorena Perez-Barbosa
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 644600, Monterrey, Mexico.
| | - Eugenio Salvador Barriga-Maldonado
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 644600, Monterrey, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 644600, Monterrey, Mexico
| | - Jazzia Emily Diaz-Angulo
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 644600, Monterrey, Mexico
| | - Gabriel Figueroa-Parra
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 644600, Monterrey, Mexico
| | - Janett Riega-Torres
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 644600, Monterrey, Mexico
| | - Dionicio Angel Galarza-Delgado
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 644600, Monterrey, Mexico
| |
Collapse
|
15
|
Brites L, Silva S, Andreoli L, Inês L. Effectiveness of reproductive health counseling of women with systemic lupus erythematosus: observational cross-sectional study at an academic lupus clinic. Rheumatol Int 2020; 41:403-408. [PMID: 32770270 DOI: 10.1007/s00296-020-04671-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
Systemic lupus erythematosus (SLE) affects women of childbearing age. To optimize fetal and maternal outcomes, effective reproductive health counseling is crucial. To analyze the effectiveness of reproductive health counseling in women with SLE and identify gaps in patient educational needs. Cross-sectional study including women aged 18-45 years fulfilling ACR'97 and/or SLICC criteria, followed at an academic lupus clinic. Participants fulfilled a questionnaire evaluating brief obstetric history, knowledge about impact of SLE in pregnancy outcomes, recall of reproductive health counseling, contraception use and reproductive healthcare received. Effectiveness of reproductive health counseling was analyzed, and potential predictors of contraceptive use (age, previous spontaneous abortion, level of knowledge about SLE and reproductive planning) were tested by multiple regression analysis. We enrolled 108 women (mean age: 34.4 ± 7.1 years; mean disease duration: 10.3 ± 7.3 years). 64.8% of the patients recalled receiving information about family planning, and 81% about contraception. Only 38% declared to be well informed about the impact of SLE on pregnancy. In this cohort, 23.2% wanted a pregnancy in the future; the remainder already had the children they wanted or planned a subsequent pregnancy. Contraceptive use was reported by 79.6% of the patients (oral contraceptives by 39.8% and intrauterine device by 20.4%), while 11.1% reported unprotected intercourses. No statistically significant predictors of contraceptive use were identified. In this academic Lupus Clinic, most SLE women of childbearing age received effective reproductive health counseling and use contraceptive methods. Their unmet needs were identified to guide optimization of patient counseling.
Collapse
Affiliation(s)
- Luisa Brites
- Rheumatology Department, Centro Hospitalar Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal
| | - Stefanie Silva
- Rheumatology Department, Centro Hospitalar Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
| | - Luis Inês
- Rheumatology Department, Centro Hospitalar Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal. .,School of Health Sciences, University of Beira Interior, Covilhã, Portugal.
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW This review summarizes recent research in the field of systemic lupus erythematosus (SLE) and pregnancy with focus on clinical and biochemical predictors of adverse pregnancy outcomes (APOs), accumulating evidence for the safety and efficacy of hydroxychloroquine (HCQ) in pregnancy, and the importance of preconception counseling. RECENT FINDINGS Ongoing research from PROMISSE investigators (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus) adds to the understanding of risk factors for APOs in SLE pregnancies, including aberrant complement activation, incomplete downregulation of lupus-associated transcription factors, and lower socioeconomic status. Evidence supporting numerous advantages for continuing HCQ in pregnancy, as well as support for low-dose aspirin in preeclampsia prevention is reviewed. Practice gaps exist among rheumatologists in ensuring effective contraception when women of childbearing age are undergoing therapy with potentially fetotoxic medications. The publication of organizational guidelines provides evidence-based recommendations on lupus pregnancy management. SUMMARY Outcomes of lupus pregnancies continue to improve with understanding of risk factors that predict APOs as well as improvements in disease management. Rheumatologists caring for women with SLE should be familiar with the most up-to-date research in order to optimize pregnancy outcomes in this population.
Collapse
|
17
|
Pluma A, Micu MC, Julià A, Marsal S, Förger F, Østensen M. A questionnaire-based study on contraceptive practice in patients with rheumatic disease found no significant difference in age-matched healthy controls. Rheumatol Int 2020; 40:1473-1480. [PMID: 32424615 DOI: 10.1007/s00296-020-04598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Birth control is crucial in preventing unplanned pregnancy. The study analyzed contraceptive practice in women and men with rheumatic disease. METHODS A questionnaire-based study investigated the actual contraceptive practices in patients of reproductive age from three European countries and compared them to age-matched healthy women and men. Associations between patient characteristics and contraception behavior were analyzed by association analysis. RESULTS No significant difference in the frequency of contraception use was found in 133 rheumatic patients compared to 122 healthy controls. The main reason for not using contraception was lack of partner or the wish to become pregnant, whereas the current use of contraception was predominantly to limit family size in general or at this stage of life. Both patients and controls preferred barrier methods (48% and 45%, respectively) followed by hormonal contraceptives (31% and 38%, respectively). Characteristics associated with less use of contraception in patients were living single, having no children, and for being religious, whereas gender and education had no influence. Treatment with teratogenic drugs was no major patient concern, and 13 of 30 female patients using methotrexate, mycophenolate mofetil, or leflunomide did not practice birth control. CONCLUSION Patients used contraception less frequently than healthy individuals, and the main reason for use was to limit family size. Contraception should be an integral part of counseling patients of fertile age, since the patient-preferred methods in case of active disease or therapy with teratogenic drugs were unreliable for the prevention of pregnancy.
Collapse
Affiliation(s)
- Andrea Pluma
- Department of Rheumatology, Vall d'Hebron University Hospital, Barcelona, Spain.,Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Mihaela C Micu
- Department of Rheumatology, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania
| | - Antonio Julià
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Sara Marsal
- Department of Rheumatology, Vall d'Hebron University Hospital, Barcelona, Spain.,Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Frauke Förger
- Department of Rheumatology, Immunology and Allergology, University Hospital Inselspital, Bern, Switzerland
| | - Monika Østensen
- Department of Rheumatology, Sorlandet Hospital, Kristiansand, Norway.
| |
Collapse
|
18
|
Talabi MB, Clowse ME, Blalock SJ, Hamm M, Borrero S. Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study. Arthritis Care Res (Hoboken) 2020; 72:452-458. [PMID: 30875455 PMCID: PMC6745289 DOI: 10.1002/acr.23872] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Little is known about whether and how rheumatologists provide family planning counseling and reproductive health care (FPCC) to reproductive-age women with rheumatic diseases. This qualitative study sought to assess rheumatologists' perspectives, attitudes, and practices regarding FPCC. METHODS Semistructured interviews were conducted with a geographically diverse US sample of rheumatologists (n = 12). Interviews were transcribed verbatim, and a code book was inductively developed based on transcript content. Two coders applied the code book to all transcripts, and coding differences were adjudicated to full agreement. The finalized coding was used to conduct a thematic analysis. RESULTS Six themes were identified across interviews. Rheumatologists said that they 1) feel responsible for providing some FPCC to patients, 2) experience tension between respecting patients' autonomy and their own anxieties about managing high-risk pregnancies, 3) view patient-initiated conversations as FPCC facilitators, and they regard lack of guidelines and the presence of competing clinical priorities as barriers to FPCC, 4) are reluctant to prescribe contraception, 5) desire greater access to resources to help guide FPCC, and 6) recognize the benefits of multidisciplinary collaboration with gynecologists. CONCLUSION Rheumatologists feel a sense of responsibility to provide some aspects of FPCC to reproductive-age female patients. However, their own apprehensions about managing complicated pregnancies may negatively influence how they advise patients about pregnancy planning or avoidance. Rheumatologists do not prescribe contraception but rarely refer patients to gynecologists for contraceptive care. Future work should focus on eliminating barriers and identifying solutions that support rheumatologists' efforts to provide high-quality FPCC to patients.
Collapse
Affiliation(s)
- Mehret Birru Talabi
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Susan J. Blalock
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Megan Hamm
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Sonya Borrero
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| |
Collapse
|
19
|
|
20
|
Contraception methods used by women with rheumatoid arthritis and psoriatic arthritis. Clin Rheumatol 2019; 38:1207-1212. [DOI: 10.1007/s10067-018-04420-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/28/2018] [Accepted: 12/27/2018] [Indexed: 11/26/2022]
|