Background/Purpose: Pregnancy in patients with systemic lupus erythematosus (SLE) is often complicated by both disease flares and risks to the fetus. It is important that young women with SLE be educated on both the risks of pregnancy and on safe and effective methods of contraception. We aimed to evaluate how often pediatric rheumatologists discuss sexual activity and contraception with their young female patients with SLE. We also aimed to assess the perception of our knowledge and how we educate our patients on both pregnancy risks and contraception in SLE. We compared these responses with those of a small cohort of providers in other medical fields.
Methods: All general pediatricians and nurse practitioners at the University of Chicago, all adult rheumatologists and trainees in Chicago who are registered with the American College of Rheumatology (ACR), and all pediatric rheumatologists and trainees in the United States who are registered with the ACR were identified. An online survey was sent to these providers to evaluate how often they take sexual histories in their adolescent and young adult female patients (ages 11-21) with SLE, the frequency with which they educate their patients on the risks of lupus in pregnancy, and if they offer contraceptive guidance.
Results: Responses were received by 56 pediatric rheumatologists, including 12 trainees, 12 nurse practitioners, 9 general pediatricians, and 7 adult rheumatologists, including 1 trainee. Relatively few pediatric rheumatologists consistently discuss sexual activity, pregnancy risks, or contraception with patients. 32% of pediatric rheumatologists were “very comfortable” taking a sexual history, compared to 16.7% of adult rheumatologists. 88.9% of general pediatricians reported taking a sexual history during at least 75% of adolescent visitis, compared to pediatric rheumatologists (26.5%). Adult rheumatologists reported obtaining sexual histories the least often among those surveyed. Only 58.8% of pediatric rheumatologists surveyed discussed the risks of pregnancy in their young female patients with active lupus, although the majority expressed adequate knowledge of these risks. Only 50% of pediatric rheumatologists reported discussing contraception with patients on teratogenic medications during at least 75% of their clinic visits despite reporting adequate familiarity with medications that can cause birth defects. Written and web-based educational resources were identified as useful tools in educating patients about pregnancy and contraception in women with lupus.
Conclusion: This preliminary survey identified a discrepancy in pediatric rheumatologists’ knowledge of the complications of pregnancy in SLE, teratogenic drugs, and contraceptive methods, and their communication of this knowledge to their young female patients with SLE. Implementing tools to help these providers feel more comfortable discussing these important topics is indicated in order to better serve this population. Surveyed physicians identified both online resources and paper handouts explaining the risks of pregnancy in young women with SLE and different methods of contraception as useful tools.
Disclosure:
D. I. De Ranieri,
None;
K. Onel,
None;
L. Wagner-Weiner,
None;
M. S. Tesher,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pregnancy-and-contraception-in-adolescents-and-teens-with-sle-are-pediatric-rheumatologists-adequately-screening-and-educating-their-patients/