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Nguyen AT, Curtis KM, Tepper NK, Kortsmit K, Brittain AW, Snyder EM, Cohen MA, Zapata LB, Whiteman MK. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep 2024; 73:1-126. [PMID: 39106314 PMCID: PMC11315372 DOI: 10.15585/mmwr.rr7304a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Abstract
The 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. MEC (CDC. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR 2016:65[No. RR-3]:1-103). Notable updates include 1) the addition of recommendations for persons with chronic kidney disease; 2) revisions to the recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, high risk for HIV infection, cirrhosis, liver tumor, sickle cell disease, solid organ transplantation, and drug interactions with antiretrovirals used for prevention or treatment of HIV infection); and 3) inclusion of new contraceptive methods, including new doses or formulations of combined oral contraceptives, contraceptive patches, vaginal rings, progestin-only pills, levonorgestrel intrauterine devices, and vaginal pH modulator. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.
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Affiliation(s)
- Antoinette T. Nguyen
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Kathryn M. Curtis
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Naomi K. Tepper
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Katherine Kortsmit
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Anna W. Brittain
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Emily M. Snyder
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Megan A. Cohen
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Lauren B. Zapata
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Maura K. Whiteman
- Division of Reproductive Health, National Center for
Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Coelingh Bennink HJT, van Gennip FAM, Gerrits MGF, Egberts JFM, Gemzell-Danielsson K, Kopp-Kallner H. Health benefits of combined oral contraceptives - a narrative review. EUR J CONTRACEP REPR 2024; 29:40-52. [PMID: 38426312 DOI: 10.1080/13625187.2024.2317295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This review presents an update of the non-contraceptive health benefits of the combined oral contraceptive pill. METHODS We conducted a literature search for (review) articles that discussed the health benefits of combined oral contraceptives (COCs), in the period from 1980 to 2023. RESULTS We identified 21 subjective and/or objective health benefits of COCs related to (i) the reproductive tract, (ii) non-gynaecological benign disorders and (iii) malignancies. Reproductive tract benefits are related to menstrual bleeding(including anaemia and toxic shock syndrome), dysmenorrhoea, migraine, premenstrual syndrome (PMS), ovarian cysts, Polycystic Ovary Syndrome (PCOS), androgen related symptoms, ectopic pregnancy, hypoestrogenism, endometriosis and adenomyosis, uterine fibroids and pelvic inflammatory disease (PID). Non-gynaecological benefits are related to benign breast disease, osteoporosis, rheumatoid arthritis, multiple sclerosis, asthma and porphyria. Health benefits of COCs related to cancer are lower risks of endometrial cancer, ovarian cancer and colorectal cancer. CONCLUSIONS The use of combined oral contraceptives is accompanied with a range of health benefits, to be balanced against its side-effects and risks. Several health benefits of COCs are a reason for non-contraceptive COC prescription.
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Affiliation(s)
| | | | | | | | | | - Helena Kopp-Kallner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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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.
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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
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Horner-Johnson W, Klein KA, Campbell J, Guise JM. "It Would Have Been Nice to Have a Choice": Barriers to Contraceptive Decision-making among Women with Disabilities. Womens Health Issues 2022; 32:261-267. [PMID: 35148954 PMCID: PMC9167240 DOI: 10.1016/j.whi.2022.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Engaging in contraceptive decisions is an important part of reproductive health for women and other people with the capacity for pregnancy. However, not all individuals capable of pregnancy have equal access to information and/or opportunities to make fully informed decisions. The goal of this study was to understand barriers women with disabilities experience around contraceptive decision-making and whether these differ based on type of disability. METHODS We conducted focus groups with 17 reproductive age adult women (aged 18-45 years). Focus groups were homogenous with regard to disability type and consisted of one group for each of the following disability categories: 1) physical disability, 2) intellectual and developmental disabilities, 3) blind or low vision, and 4) Deaf users of American Sign Language. Data were collected in the Portland, Oregon, metropolitan area during 2016-2017. We analyzed focus group transcripts using content analysis. RESULTS Barriers to informed contraceptive decision-making emerged in five main thematic areas: 1) lack of information in accessible formats, 2) incomplete information about contraceptive side effects, 3) limited clinician knowledge and relevant research specific to the care of women with disabilities, 4) taboos around discussing sexual activity, and 5) limited opportunities for shared contraceptive decision-making. CONCLUSIONS Women with disabilities faced numerous barriers to contraceptive decision-making. Although the barriers differed somewhat by disability type, many barriers were consistent across groups, suggesting commonalities associated with the experience of disability in the context of contraceptive decision-making. Increased attention to the reproductive health needs of people with disabilities is important for improving health care equity and quality.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon.
| | | | | | - Jeanne-Marie Guise
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Lopane CM, Comstock B, Nagel AK, Gandhi MA. Combined oral contraceptive use in rheumatoid arthritis for the purpose of pregnancy prevention and additional benefits: A narrative review. J Obstet Gynaecol Res 2021; 48:306-312. [PMID: 34889495 DOI: 10.1111/jog.15097] [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: 06/22/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
Combined oral contraceptives are a common method of contraception and many females prefer them regardless of their medical history. The use in patients with rheumatoid and autoimmune disorders has not been extensively studied with previous reviews focusing on the safety component. This review seeks to address the effectiveness and benefits of utilizing combined oral contraceptives in females with rheumatoid arthritis (RA). Current literature regarding combined oral contraceptives was surveyed for its use in RA and two PubMed searches were conducted, yielding 202 and 142 results, respectively. Results were screened and analyzed for relevance to this review topic. Eighteen results, consisting of clinical trials, observational studies, patient cases, and meta-analyses were used in this narrative review. Historically, it was thought that females with an autoimmune disorder such as RA need to be on contraception due to the teratogenicity potential with disease-modifying therapy but no evidence exists about which type of contraception is the most effective and least interacting. Current evidence available shows no preference for types of contraception in this population, but it has been demonstrated that combination oral contraceptives may provide contraceptive benefits and have a potential for other benefits such as less disability and the prevention of disease progression. Although current evidence provides reasoning to believe combination oral contraceptives are safe and efficacious in patients with RA and may even offer additional benefits, further studies and clinical trials are needed to completely understand the role combination oral contraceptives play in this patient population.
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Affiliation(s)
- Cassandra M Lopane
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Brianne Comstock
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Angela K Nagel
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Mona A Gandhi
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
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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.
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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.
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Sammaritano LR. Contraception and preconception counseling in women with autoimmune disease. Best Pract Res Clin Obstet Gynaecol 2019; 64:11-23. [PMID: 31679995 DOI: 10.1016/j.bpobgyn.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
Appropriate contraception and preconception counseling are critical for women of reproductive age with systemic autoimmune diseases (AIDs) because clinical diagnosis, rheumatology medications, and disease activity may impact the safety or efficacy of certain contraceptives as well as the risk of adverse pregnancy outcomes. The presence of antiphospholipid (aPL) antibodies (anticardiolipin, anti-β2 glycoprotein I, and lupus anticoagulant) is the most important determinant of contraception choice, as women with these antibodies should not receive estrogen-containing contraceptives because of the increased risk of thrombosis. Prepregnancy counseling generally includes the assessment of preexisting disease-related organ damage, current disease activity, aPL antibodies, anti-Ro/SS-A and anti-La/SS-B antibodies, and medication safety in pregnancy. Quiescent AID for six months on pregnancy-compatible medications optimizes maternal and fetal/neonatal outcomes for most patients.
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Affiliation(s)
- Lisa R Sammaritano
- Hospital for Special Surgery - Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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Amini L, Kalhor M, Haghighi A, Seyedfatemi N, Hosseini F. Effect of oral contraceptive pills on rheumatoid arthritis disease activity in women: A randomized clinical trial. Med J Islam Repub Iran 2018; 32:61. [PMID: 30643736 PMCID: PMC6325288 DOI: 10.14196/mjiri.32.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Rheumatoid arthritis is one of the most common autoimmune diseases. Because immunological changes can be induced by steroid hormones, it seems that oral contraceptive pills can affect the severity of the disease. In this study, we examined the effect of oral contraceptive pills on rheumatoid arthritis activity in women. Methods: This blinded randomized clinical control trial was performed in the selected rheumatology centers in Tehran, Iran, in 2011. A total of 100 women with rheumatoid arthritis were included (50 in the intervention and 50 in the control groups), and those in the intervention group took oral contraceptive pills intermittently for 8 weeks. Disease activity was measured at 1 and 9 weeks based on DAS-28, which includes the number of tender joints, number of swollen joints, ESR, and GH. Data were analyzed using SPSS-16, and significance level was set at p≤0.05. This study was registered in IRCT (number: 138904224364N1) and all interventions were done after receiving confirmation from the Ethical Committee of Tehran University of Medical Sciences (Code: 250/ 6441). Results: After administering oral contraceptive pills to the intervention group, we found significant differences between the 2 groups in disease activity and severity scores (p=0.04). Intervention group showed lower swollen joints score (p=0.02), lower joint tenderness score (p=0.02), and lower general health score (p=0.001) than the control group. Conclusion: According to the results of this study, oral contraceptive pills can improve rheumatoid arthritis activity and severity. As these pills are used for contraception, women with rheumatoid arthritis can benefit from both effects of these pills.
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Affiliation(s)
- Leila Amini
- Department of Reproductive Health, School of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mehri Kalhor
- School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Anoushe Haghighi
- Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Naiemeh Seyedfatemi
- Nursing Care Research Center (NCRC), Iran University of Medical Sciences, Tehran, Iran
| | - Fatemah Hosseini
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Abstract
Contraception represents an important area of reproductive health for patients with rheumatic diseases given the potential pregnancy risks associated with active disease, teratogenic medications, and severe disease-related damage. A high proportion of patients with rheumatic disease do not use effective contraception. Long-acting contraceptives are most effective. Antiphospholipid-negative patients with stable systemic lupus erythematosus may use oral combined contraceptives. Antiphospholipid-positive patients, or patients with rheumatic disease with other risk factors for thrombosis, should avoid estrogen-containing contraceptives. Contraceptive methods should be addressed by both the rheumatologist and gynecologist to determine the safest, most effective, and most convenient form for each patient.
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Affiliation(s)
- Lisa R Sammaritano
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY 10021, USA.
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Böttcher B, Wildt L. Autoimmunerkrankungen und orale Kontrazeption. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Briggs AM, Jordan JE, Ackerman IN, Van Doornum S. Establishing cross-discipline consensus on contraception, pregnancy and breast feeding-related educational messages and clinical practices to support women with rheumatoid arthritis: an Australian Delphi study. BMJ Open 2016; 6:e012139. [PMID: 27633637 PMCID: PMC5030591 DOI: 10.1136/bmjopen-2016-012139] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Recognising the need for a best-practice and consistent approach in providing care to women with rheumatoid arthritis (RA) in relation to (1) general health, (2) contraception, (3) conception and pregnancy, (4) breast feeding and (5) early parenting, we sought to achieve cross-discipline, clinical consensus on key messages and clinical practice behaviours in these 5 areas. DESIGN 3-round eDelphi study. In round 1, panellists provided free-text responses to open-ended questions about care for women with RA across the 5 areas. Subsequently, panellists refined and scored the synthesised responses, presented as metathemes, themes and detailed elements. Where ≥5% of panellists did not support a theme in a given round, it was removed. SETTING Panel of practicing Australian rheumatologists (n=22), obstetricians/obstetric medicine physicians (n=9) and pharmacists (n=5). RESULTS 34 (94.4%) panellists participated in all 3 rounds. The panel supported 18 themes across the 5 areas (support/strongly support: 88.2-100%) underpinned by 5 metathemes. Metathemes focused on coordination in information delivery, the mode and timing of information delivery, evidence underpinning information, engagement of the right health professionals at the right time and a non-judgemental approach to infant feeding. Themes included practices for primary prevention of chronic disease and their sequelae, the importance of contraception and planning pregnancy and breast feeding, close monitoring of medications, supporting mental well-being, managing disease activity and providing practical support for early parenting. CONCLUSIONS A cross-disciplinary clinical panel highly supported key information and clinical practices in the care for women with RA across the continuum of contraception to early parenting within a whole-person, chronic disease management approach.
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Affiliation(s)
- Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Move: Muscle, Bone and Joint Health, Melbourne, Victoria, Australia
| | | | - Ilana N Ackerman
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Melbourne EpiCentre, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sharon Van Doornum
- Department of Medicine, Melbourne EpiCentre, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Rheumatology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Saavedra Salinas MÁ, Barrera Cruz A, Cabral Castañeda AR, Jara Quezada LJ, Arce-Salinas CA, Álvarez Nemegyei J, Fraga Mouret A, Orozco Alcalá J, Salazar Páramo M, Cruz Reyes CV, Andrade Ortega L, Vera Lastra OL, Mendoza Pinto C, Sánchez González A, Cruz Cruz PDR, Morales Hernández S, Portela Hernández M, Pérez Cristóbal M, Medina García G, Hernández Romero N, Velarde Ochoa MDC, Navarro Zarza JE, Portillo Díaz V, Vargas Guerrero A, Goycochea Robles MV, García Figueroa JL, Barreira Mercado E, Amigo Castañeda MC. Guías de práctica clínica para la atención del embarazo en mujeres con enfermedades reumáticas autoinmunes del Colegio Mexicano de Reumatología. Parte II. ACTA ACUST UNITED AC 2015; 11:305-15. [DOI: 10.1016/j.reuma.2014.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/12/2014] [Indexed: 12/14/2022]
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Mahendira D, Thavaneswaran A, Carty A, Haroon N, Anton A, Passalent L, Alnaqbi KA, Savage L, Aslanyan E, Inman RD. Analysis of the effect of the oral contraceptive pill on clinical outcomes in women with ankylosing spondylitis. J Rheumatol 2015; 41:1344-8. [PMID: 24931958 DOI: 10.3899/jrheum.130996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE There are unexplained sex-specific changes in the clinical expression of ankylosing spondylitis (AS). We sought to examine the potential effect of exogenous estrogen in the form of oral contraceptive pills (OCP) on AS initiation and severity. METHODS This cross-sectional study consisted of women with AS from the membership of the Spondylitis Association of America. Measures of disease severity included use of biological agents and hip replacement surgery, while Bath AS Functional Index (BASFI) scores served as a surrogate marker of disability. Information was obtained using a patient questionnaire on patient demographics, OCP use, pregnancy history, AS duration, medication use, and hip replacement. RESULTS There were 571 women with AS who participated in our study, consisting of 448 OCP ever-users and 123 non-OCP users. The mean age of OCP users was 42.7 yrs (± 11.5) and of non-OCP users, 48.4 yrs (± 12.1). No difference was noted in the age at initial onset of back pain. However, OCP users were significantly younger at the time of diagnosis of AS (36.5 yrs vs 39.1 yrs, p = 0.02). There were no significant differences between the 2 groups in tumor necrosis factor inhibitor or opioid use, BASFI scores, pregnancy complications, or hip surgery. CONCLUSION The use of exogenous estrogens in the form of OCP is not associated with a measurable effect on initiation or severity of AS. Biologic and social factors may contribute to earlier diagnosis of AS in OCP users. This is the largest study to date investigating the potential effect of exogenous estrogens in women with AS.
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Affiliation(s)
- Dharini Mahendira
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH.
| | - Arane Thavaneswaran
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Adele Carty
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Nigil Haroon
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Ammepa Anton
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Laura Passalent
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Khalid A Alnaqbi
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Laurie Savage
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Elin Aslanyan
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
| | - Robert D Inman
- From the Division of Rheumatology, University of Toronto, St. Michael's Hospital (SMH), and the Division of Rheumatology, University of Toronto, Toronto Western Hospital (TWH), Toronto, Ontario, Canada; the Division of Rheumatology, Al Ain Hospital, United Arab Emirates; and the Spondylitis Association of America (SAA), Van Nuys, California, USA.D. Mahendira, MD, MSc, FRCPC, SMH; A. Thavaneswaran, MMath, BSc; A. Carty, BPH; N. Haroon, MD, PhD, DM; A. Anton, BSc; L. Passalent, BScPT, MHSc, TWH; K.A. Alnaqbi, MD, MSc, FRCPC, TWH, and Division of Rheumatology, Al Ain Hospital; L. Savage, MS; E. Aslanyan, BA, SAA; R.D. Inman, MD, FRCPC, TWH
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14
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Abstract
PURPOSE OF REVIEW The purpose of this study is to encourage discussion of reproduction issues in all patients of fertile age in order to prevent unplanned and ill-timed pregnancies in patients with rheumatoid arthritis (RA). RECENT FINDINGS Counselling patients who desire children requires consideration of relevant reproductive health issues, including fertility, interaction of pregnancy and RA, and management during pregnancy and lactation. RA patients have no disease-related restrictions in regard to contraception, but need to be counselled on safe birth control particularly during treatment with potentially teratogenic drugs. In spite of mostly beneficial effects of pregnancy on RA, active disease and aggressive drug treatment can impair pregnancy outcomes. Options for drug therapy, though limited, may help to maintain low disease activity during pregnancy and lactation. SUMMARY Careful preconception counselling and risk assessment is important in RA women, with a particular focus on preventing unplanned pregnancy by information on contraception. Antibody status and all medications need to be reviewed before pregnancy. Maintaining low disease activity before and during pregnancy is crucial for good outcomes. Preconceptional counselling shared with all health professionals engaged in the care of a patient helps to ensure healthy pregnancy outcomes for mother and child.
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15
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Coulson EJ, Hanson HJM, Foster HE. What does an adult rheumatologist need to know about juvenile idiopathic arthritis? Rheumatology (Oxford) 2014; 53:2155-66. [PMID: 24987157 DOI: 10.1093/rheumatology/keu257] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
JIA is the most common chronic inflammatory arthritis in children and young people and an estimated one-third of individuals will have persistent active disease into adulthood. There are a number of key differences in the clinical manifestations, assessment and management of JIA compared with adult-onset arthritis. Transition and transfer to adult services present significant challenges for many patients, their families and health care professionals. We describe key clinical issues relevant to adult rheumatology health care teams responsible for ongoing care of these young people.
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Affiliation(s)
- Elizabeth J Coulson
- Rheumatology Department, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust and Musculoskeletal Research Group, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Helen J M Hanson
- Rheumatology Department, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust and Musculoskeletal Research Group, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Helen E Foster
- Rheumatology Department, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust and Musculoskeletal Research Group, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Rheumatology Department, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust and Musculoskeletal Research Group, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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16
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Concepts of contraception for adolescent and young adult women with chronic illness and disability. Dis Mon 2012; 58:258-320. [PMID: 22510362 DOI: 10.1016/j.disamonth.2012.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sexual behavior is common in adolescents and young adults with or without chronic illness or disability, resulting in high levels of unplanned pregnancy and STDs. Individuals with chronic illness or disability should not receive suboptimal preventive health care. These individuals have a need for counseling regarding issues of sexuality and contraception. Sexually active adolescent and young adult women can be offered safe and effective contraception if they wish to avoid pregnancy. Women with chronic illnesses and disabilities who are sexually active should also be offered contraception based on their specific medical issues. Condoms are also recommended to reduce STD risks. Table 36 summarizes basic principles of contraception application for specific illnesses, which have been identified since the release of the combined OC in 1960. Clinicians should also consider the noncontraceptive benefits of this remarkable and life-changing technology that allows all reproductive age women to improve their lives, including those with chronic illnesses and disabilities.
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17
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Jacobson JC, Aikins Murphy P. United States medical eligibility criteria for contraceptive use 2010: a review of changes. J Midwifery Womens Health 2011; 56:598-607. [PMID: 22060220 DOI: 10.1111/j.1542-2011.2011.00093.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the late 1990s, the World Health Organization (WHO) created the Medical Eligibility Criteria for Contraceptive Use (MEC), which provide evidence-based recommendations for safe and effective contraception in women with medical problems. The WHO MEC incorporate the best available evidence, are periodically updated, and are designed to be modified for specific populations. The US Centers for Disease Control and Prevention published US MEC in 2010. Changes to WHO guidelines for use in the US population include the following areas: breastfeeding, intrauterine device use, valvular heart disease, ovarian cancer, uterine fibroids, and venous thromboembolism. Medical conditions not covered by WHO recommendations but added to the US MEC include contraceptive guidance for women with inflammatory bowel disease, history of bariatric surgery, rheumatoid arthritis, endometrial hyperplasia, history of peripartum cardiomyopathy, and history of solid organ transplant. This article reviews the changes and additions to WHO MEC found in the US MEC.
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Affiliation(s)
- Janet C Jacobson
- Universityof Utah, Department of Obstetrics and Gynecology, Salt Lake City, Utah, USA.
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