Counseling on Family Planning and Contraception, and Pregnancy Outcome in Women with Rheumatic Diseases: Analysis of 398 Patient-Reported Questionnaires from a Multicenter Italian Study

Francesca Dall'Ara¹, Maria Grazia Lazzaroni¹, Laura Andreoli¹, Marilia Rodrigues², Carolina Benigno³, Elena Bartoloni-Bocci⁴, Corrado Capochiaro⁵, Cecilia B. Chighizola⁶, Paola Conigliaro⁷, ADA Corrado⁸, Salvatore D'Angelo⁹, maria favaro¹⁰, Elena Generali¹¹, Maria Gerosa¹², M larosa¹³, Marianna Meroni¹⁴, Melissa Padovan¹⁵, Giulia Pazzola¹⁶, Susanna Peccatori¹⁷, Imma Prevete¹⁸, Véronique Ramoni¹⁹, G Sebastiani²⁰, Chiara Tani²¹, Marica Trevisani²², M Vadacca²³, Ester Vivaldelli²⁴, E Visalli²⁵, L Zuliani²⁶, A Afeltra²³, Elena Baldissera²⁷, Antonio Brucato²⁸, Francesco Paolo Cantore²⁹, Roberto Caporali³⁰, Maurizio Cutolo³¹, Andrea Doria³², Rosario Foti³³, Armando Gabrielli³⁴, Roberto Gerli³⁵, Marcello Govoni³⁶, Armin Maier²⁴, Nazzarena Malavolta³⁷, Pier Luigi Meroni³⁸, Giovanni Minisola¹⁸, Carlo Maurizio Montecucco³⁹, Marta Mosca⁴⁰, Ignazio Olivieri⁴¹, Giuseppe Paolazzi⁴², Roberto Perricone⁴³, N Romeo⁴⁴, Amelia Ruffatti⁴⁵, Maria Grazia Sabbadini⁵, Carlo Salvarani⁴⁶, Carlo Selmi⁴⁷, Luigi Sinigaglia⁴⁸ and Angela Tincani¹, ¹Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, Brescia, Italy, ²Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, Coimbra, Portugal, ³University Federico II, Napoli, Italy, Napoli, Jamaica, ⁴Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy, ⁵Ospedale San Raffaele, Milano, Italy, milano, Italy, ⁶Department of Clinical Sciences and Community Health, University of Milan, IRCCS Istituto Auxologico Italiano, Milano, Italy, ⁷Policlinico and University of Tor Vergata, Roma, Italy, roma, Italy, ⁸Ospedali Riuniti of Foggia, Foggia, Italy, foggia, Italy, ⁹Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, matera, Italy, ¹⁰Rheumatology Unit, University and Azienda Ospedaliera of Padova, Padova, Italy, padova, Italy, ¹¹Rheumatology and Clinical Immunology, Humanitas Research Hospital, Rozzano (MI), Italy, ¹²University of Milan, Istituto Ortopedico Gaetano Pini, Milano, Italy, ¹³University and Azienda Ospedaliera of Padova, Padova, Italy, padova, Italy, ¹⁴University of Genova-IRCCS San Martino Genova, Genova, Italy and ASST Papa Giovanni XXIII, Bergamo, Italy, genova, Italy, ¹⁵Department if Clinical and Experimental Medicine, University of Ferrara, Section of Rheumatology, Ferrara, Italy, ¹⁶Rheumatology Unit, Internal Medicine Department, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy, ¹⁷Azienda Provinciale Servizi Sanitari, Trento, Italy, trento, Italy, ¹⁸Azienda Ospedaliera San Camillo, Roma, Italy, Roma, Italy, ¹⁹Rheumatology, Policlinico San Matteo, Pavia, Italy, ²⁰15 Azienda Ospedaliera San Camillo, Roma, Italy, roma, Italy, ²¹Clinical and Experimental Medicine, University of Pisa, Rheumatology Unit, Pisa, Italy, ²²Rheumatology Unit, Internal Medicine, Policlinico S.Orsola-Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, ²³University Campus Biomedico, Roma, Italy, roma, Italy, ²⁴Ospedale of Bolzano, Bolzano, Italy, bolzano, Italy, ²⁵A.O.U. Policlinico Vittorio Emanuele, Catania, Italy, catania, Italy, ²⁶Ospedali Riuniti and University of Ancona, Ancona, Italy, ancona, Italy, ²⁷Internal Medicine and Clinical Immunology, Vita-Salute San Raffaele University, Milan, Italy, ²⁸Internal Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy, ²⁹Ospedali Riuniti of Foggia, Foggia, Italy, Foggia, Italy, ³⁰Università di Pavia, Pavia, Italy, ³¹Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy, Genova, Italy, ³²Rheumatology Unit, Department of Medicine - DIMED, Department of Medicine-DIMED, University of Padova, Padova, Italy, ³³Rheumatology Unit, Vittorio-Emanuele University Hospital of Catania, Catania, Italy, ³⁴Medical Clinic Unit, Department of Internal Medicine, Ospedali Riuniti, Ancona, Italy, ³⁵Clinical and Experimental Medicine, Rheumatology Unit, University of Perugia, Italy, Perugia, Italy, ³⁶Department of Clinical and Experimental Medicine, Rheumatology Unit-Azienda Ospedaliera-Universitaria Sant'Anna, Ferrara, Italy, ³⁷Internal medicine Unit, Policlinico S. Orsola Malpighi, Bologna, Italy, ³⁸Rheumatology Department, University of Milan, Istituto Ortopedico Gaetano Pini, Milano, Italy, ³⁹Division of Rheumatology, University of Pavia School of Medicine, IRCCS Policlinico San Matteo Foundation, Pavia, Italy, ⁴⁰Rheumatology Unit, University of Pisa, Pisa, Italy, ⁴¹U.O. Reumatologia, A.O. Ospedale San Carlo, Potenza, Italy, ⁴²Rheumatology Unit, Santa Chiara Hospital, Trento, Italy, ⁴³Rheumatology, allergology and clinical immunology, University of Rome Tor Vergata, Rome, Italy, ⁴⁴Ospedale S.Croce e Carle, Cuneo, Italy, cuneo, Italy, ⁴⁵Azienda Ospedaliera of Padova, University of Padova, Padova, Italy, ⁴⁶Rheumatology Unit, Arcispedale S Maria Nuova, IRCCS, Reggio Emilia, Italy, ⁴⁷Internal Medicine- Unit of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Italy, ⁴⁸University of Milan, Milan, Italy, milano, Italy

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Counseling, pregnancy and rheumatic disease

Session Information

Date: Tuesday, November 15, 2016

Title: Reproductive Issues in Rheumatic Disorders - Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

COUNSELING ON FAMILY PLANNING AND CONTRACEPTION, AND PREGNANCY OUTCOME IN WOMEN WITH RHEUMATIC DISEASES: ANALYSIS OF 398 PATIENT-REPORTED QUESTIONNAIRES FROM A MULTICENTER ITALIAN STUDY

Background/Purpose: Rheumatic diseases (RD) predominantly affect young women during reproductive age. Pregnancy, contraception and family planning are crucial for the quality of life of these patients. We aimed at investigating ‘women’s health’ issues through a self-reported questionnaire. Answers from patients with connective tissue diseases (CTD) vs. chronic arthritis (CA) were compared.

Methods: 24 Italian participating centers distributed a self-reported questionnaire (65 multiple-choice and 12 open-answer questions) to women with RD (> 18years).

Results: Answers were collected from 279 CTD and 163 CA; the mean age at diagnosis was 31.6 and 30.6 years respectively. Subsequent analysis was performed on 249 CTD vs. 149 CA. Patients who developed a RD after 45 years old were excluded from this analysis.

Nearly 40% of all patients declared that RD influenced their desire to have children: about 55% of them reduced the number of children they wanted (Table 1). In particular 39% CA vs.29%CTD declared to be afraid of being mother because of their disability.

24% CTD vs. 18% CA had at least one miscarriage; 21% CTD vs. 2% CA had more than one miscarriage.

31% CTD and 34% CA were never asked by their rheumatologist about the desire to have children. 61% CTD vs.70% CA received counseling about contraception, given by a gynecologist (58% vs. 64%), rheumatologist (22% vs. 14%), or both (7% vs. 9%).

About 60% in both groups received a counseling before pregnancy: 34% vs. 39% of them from both rheumatologist and gynecologists, 14% vs. 22% only by rheumatologist. The counseling positively changed the family planning in 64% and 59% respectively.

About 50% of all patients had no knowledge about the use of immunosuppressive drugs during pregnancy. About 40% of patients who were in menopause declared that it started before 45 years of age.

Conclusion: This survey suggested that CTD have a major impact on reproductive planning and restriction of family size, possibly mediated by the reported increased rate of miscarriages as compared to CA. The concerns about reproductive issues could be positively overcome by adequate counseling.

Rheumatologists should implement the discussion about family planning and the compatibility of drugs with pregnancy in the management of young women with RD. This is particulary relevant in CTD patients in whom contraception and pregnancy have particular implications.

Early menopause appears to be a relevant issue in women with RD.

Acknowledgements: the statistical analysis was supported by an unrestricted grant by UCB Pharma

The disease has reduced your desire to have children?

	CTD	CA
NO	36/91 (40%)	22/54 (41%)
YES	52/91 (57%)	28/54 (52%)
No Answer	3/91 (3%)	4/54 (7%)


If yes, I reduced the number of children that I wanted, because I was afraid…	CTD	CA
…of not being able to take care of them because of the disease	26/91 (29%)	21/54 (39%)
…that the child could have the same disease	15/91 (17%)	8/54 (15%)
…that drugs or disease could harm the baby	26/91 (29%)	20/54 (37%)

Table 1. Reasons for reduced family size in patients who declared that

their RD had influenced their desire of having children

Disclosure: F. Dall'Ara, None; M. G. Lazzaroni, None; L. Andreoli, None; M. Rodrigues, None; C. Benigno, None; E. Bartoloni-Bocci, None; C. Capochiaro, None; C. B. Chighizola, None; P. Conigliaro, None; A. Corrado, None; S. D'Angelo, None; M. favaro, None; E. Generali, None; M. Gerosa, None; M. larosa, None; M. Meroni, None; M. Padovan, None; G. Pazzola, None; S. Peccatori, None; I. Prevete, None; V. Ramoni, None; G. Sebastiani, None; C. Tani, None; M. Trevisani, None; M. Vadacca, None; E. Vivaldelli, None; E. Visalli, None; L. Zuliani, None; A. Afeltra, None; E. Baldissera, None; A. Brucato, None; F. P. Cantore, None; R. Caporali, Lilly, Abbvie, MSD, Pfizer, UCB, Celgene, Mundiharma, 5; M. Cutolo, Actelion, BMS, Sanofi-Aventis, 2,Actelion, BMS, Sanofi-Aventis, 5; A. Doria, None; R. Foti, None; A. Gabrielli, None; R. Gerli, None; M. Govoni, None; A. Maier, None; N. Malavolta, None; P. L. Meroni, None; G. Minisola, None; C. M. Montecucco, None; M. Mosca, None; I. Olivieri, None; G. Paolazzi, None; R. Perricone, None; N. Romeo, None; A. Ruffatti, None; M. G. Sabbadini, None; C. Salvarani, None; C. Selmi, None; L. Sinigaglia, None; A. Tincani, None.

To cite this abstract in AMA style:

Dall'Ara F, Lazzaroni MG, Andreoli L, Rodrigues M, Benigno C, Bartoloni-Bocci E, Capochiaro C, Chighizola CB, Conigliaro P, Corrado A, D'Angelo S, favaro M, Generali E, Gerosa M, larosa M, Meroni M, Padovan M, Pazzola G, Peccatori S, Prevete I, Ramoni V, Sebastiani G, Tani C, Trevisani M, Vadacca M, Vivaldelli E, Visalli E, Zuliani L, Afeltra A, Baldissera E, Brucato A, Cantore FP, Caporali R, Cutolo M, Doria A, Foti R, Gabrielli A, Gerli R, Govoni M, Maier A, Malavolta N, Meroni PL, Minisola G, Montecucco CM, Mosca M, Olivieri I, Paolazzi G, Perricone R, Romeo N, Ruffatti A, Sabbadini MG, Salvarani C, Selmi C, Sinigaglia L, Tincani A. Counseling on Family Planning and Contraception, and Pregnancy Outcome in Women with Rheumatic Diseases: Analysis of 398 Patient-Reported Questionnaires from a Multicenter Italian Study [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/counseling-on-family-planning-and-contraception-and-pregnancy-outcome-in-women-with-rheumatic-diseases-analysis-of-398-patient-reported-questionnaires-from-a-multicenter-italian-study/. Accessed .

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