Background/Purpose:
Patients with autoimmune diseases are often prescribed medications that are
known to be teratogenic. Amongst women of child-bearing ages taking such
medications, roughly half adhere to contraceptive guidelines. We sought to
describe the contraception practices of women of child bearing age prescribed a
teratogenic medication in our academic medical center outpatient rheumatology
clinic. 

Methods: In
an academic rheumatology clinic, women ages 18 to 45 years old were screened
for use of methotrexate, leflunomide, mycophenolate, and cyclophosphamide. A
retrospective chart review was conducted on eligible women to determine the type
of contraception documented. This project was part of an IRB-approved quality
improvement project to assess rates of contraception documentation and
contraceptive counseling. 3003 charts were reviewed, representing 12 one-week
blocks over a period of ten. Descriptive statistics were used to quantify
patient demographics and the percent of patients using each type of
contraception.  Women were grouped based on the relative effectiveness of
contraceptive based on the pregnancy rate with ‘usual use’: “highly-effective”(≥95%), “moderately effective”
(90-94%), or “ineffective” forms of birth control.  We included abstinence in
the “ineffective” group as it is only effective if practiced 100% of the time
and many women in this group do not have a plan for contraception. 

Results: We
reviewed 3003 charts; 181 women between ages 18-45 took a teratogenic
medication. The average age of eligible women was 34. Most women were receiving
methotrexate (49%), followed by mycophenolate (41%), leflunomide (6%),
cyclophosphamide (3%) and combination medications (2%). Of the 181 women, 67
had did not have a form of contraception documented, leaving 114 patients for
whom we could describe contraception type.   Of those with documented
contraception, 20% were unable to conceive due to hysterectomy or menopause and
another 24% were on highly effective contraception (Table).  Another 29% were
on effective contraception.  Only 24% were on ineffective contraception and the
majority of these were women who reported abstinence. 

Conclusion: In
this study, we found that the majority of women between ages 18-45 on
teratogenic rheumatologic medications in an academic practice were either
unable to conceive or on effective or highly effective contraception.  Importantly,
we identified a primary target cohort of patients not using any form of
contraception (abstinence only) or using condoms only.