Background/Purpose: Rheumatologic diseases can affect females of reproductive age. Medications utilized for treatment of these diseases can be associated with harmful consequences in pregnancy. Unfortunately, not all women receive contraception despite this risk.

Methods: A retrospective chart review conducted at a single tertiary care center identified the most recent 500 women between ages 18-50 seen in outpatient rheumatology clinic with ICD codes for rheumatoid arthritis, systemic lupus erythematosus, vasculitis, and systemic sclerosis who had been prescribed methotrexate, leflunomide, mycophenolate mofetil, or cyclophosphamide between 06/01/2008-06/01/2016. Individuals were allowed to be included in multiple categories if they had received multiple diagnoses and different immunosuppressants over the time of follow-up. Additional data collected included: age at office visit, self-reported race, primary language, marital status, and type of contraception. Contraception was identified by searching medication lists, past medical/surgical history, and procedure codes. Fisher’s exact test and chi-square were utilized.

Results: Of the 500 women, 62 (12%) were between ages 18-29, 127 (25%) were 30-39, and 311 (62%) were 40-50. Almost half were married (243, 49%). The vast majority were English speaking (478, 96%). Individuals who self reported as white represented 301 (60%), black 127 (25%), other 46 (9%), Asian 15 (3%), Native American 5 (1%), two races 4 (1%), Pacific Islander 1 (0.2%), and unknown 1 (0.2%). Rheumatoid arthritis was the most common diagnosis (338, 68%), followed by systemic lupus erythematosus (188, 38%), systemic sclerosis (69, 14%), and vasculitis (33, 7%). Methotrexate was the most common medication (342, 68%), followed by mycophenolate mofetil (191, 38%), leflunomide (76, 15%), and cyclophosphamide (25,5%).

In total, 290 women (58%) received some form of contraception. The most common forms of contraception were hysterectomy (104, 21%) and combination hormone therapy (oral contraceptives and vaginal ring) (95, 19%). The following forms of contraception were also used with rates as follows: tubal ligation in 56 (11%), intrauterine devices in 34 (7%), medroxyprogesterone injections in 21 (4%), progesterone implant in 8 (2%), and progesterone only pill in 1 patient (0.2%).

Women who self-reported as white race were more likely to utilize contraception (63%) than non-white patients (50%) (p=0.003). There was no statistically significant difference in the rates of contraception based on age, marital status, disease, or immunosuppressant utilized.

Conclusion: This study identifies that contraception is not being utilized in all patients when it would be recommended. Self-reported race/ethnicity was one factor associated with different rates of contraception. Understanding the magnitude of patients not receiving contraception and factors associated with this will better inform strategies to help improve rates of contraception in those exposed to teratogens.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/contraceptive-use-in-patients-with-rheumatologic-disease-on-teratogenic-medications-rate-of-use-and-related-factors/