Background/Purpose:

Because many autoimmune conditions preferentially affect women of childbearing age and both disease and treatment can negatively affect pregnancy outcomes, healthcare providers to women with rheumatologic diseases must be aware of and counsel patients regarding reproductive health issues.

Prior studies have shown that women with lupus of childbearing age are at high risk of unintended pregnancy and pregnancy exposure to teratogenic medication (1, 2). Our academic medical center provides care to a diverse urban population. We designed this study:

1. To assess baseline awareness of reproductive health issues in our patient population.
2. To evaluate the efficacy of an educational intervention, in addition to routine counselling, in improving patients’ reproductive health knowledge.

Methods:

This descriptive study was performed using a survey instrument. Premenopausal females, between the age of 18 to 45 who were seen at Drexel University College of Medicine Rheumatology clinics, with an underlying diagnosis of rheumatoid arthritis, systemic lupus erythematosus, sero-negative spondyloarthropathy, mixed connective tissue disease, scleroderma, and vasculitis were recruited. Participants were asked to complete a baseline survey and were later randomized 1:1 to receive either pamphlet or audiovisual intervention, followed by a post-intervention survey at routine followup visit.

Results:

74 participants enrolled in the study thus far. All completed the baseline survey. The majority were age 25-30 (34%), African American (44.6%) and at least partially-college educated (74%). 41% were unemployed. 49 participants were randomized to and completed the intervention; 22 respondents completed the post-intervention survey. Pre-intervention, 39% of respondents reported consistent contraceptive use; 47% of women who were sexually active with men reported contraceptive use. Of the 53% of sexually active women not using birth control (at risk of becoming pregnant), 59% were also using teratogenic medications.

Post- intervention, 20% more women felt knowledgeable about medication effects on fertility, 21% more about effects on pregnancy and 14% more about effects on breastfeeding compared to pre-intervention.

Conclusion:

Survey respondents report poor baseline knowledge of the impact their diseases and treatments on reproductive health. Preliminary post-intervention data show an increase in knowledge regarding medication effects on reproductive health [in both groups]. With these data, we hope to raise awareness of reproductive health issues and improve counseling of women with autoimmune diseases using the educational interventions to maximize quality of care.

References:

1. Schwarz EB, Manzi S. Risk of unintended pregnancy among women with systemic lupus erythematosus.Arthritis Rheum. 2008 Jun 15;59(6):863-6.
2. Yazdany J, Trupin L, et al. Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality. Arthritis Care Res (Hoboken). 2011 Mar;63(3):358-65.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/awareness-of-fertility-and-contraception-issues-among-women-with-rheumatologic-diseases/