Background/Purpose: Rheumatic diseases including rheumatoid arthritis, seronegative inflammatory arthritis and systemic lupus erythematosus can be associated with significant morbidity in women of child-bearing age. Both these diseases themselves and their treatments have been shown to impact fetal and maternal outcomes.  Although there is growing evidence outlining safety of many anti-rheumatic drugs (ARDs) in pregnancy, many patients discontinue treatments in the peripartum period due to concern of fetal harm. This study sought to identify perinatal medication use patterns at a single tertiary care center and to understand patient perspectives surrounding their use.

Methods: Electronic medical records were reviewed for women attending the rheumatic diseases in pregnancy clinic, a rheumatology clinic with subspecialty input, at St. Michael’s Hospital in Toronto, Canada, from January 2013 until November 2019.  A 12-item questionnaire was administered to women attending this clinic to explore patient perspectives. Data was analyzed using descriptive statistics.

Results: Thirty-eight women and forty-five pregnancies were identified, with rheumatoid arthritis (N=12, 32%), systemic lupus erythematosus (N=18, 27%) and seronegative arthritis (n=8, 16%) representing the majority. Twenty-nine patients (60%) were exposed to disease modifying anti-rheumatic drugs (DMARDs) and eight patients (16%) were exposed to biologics during pregnancy. Of those who experienced medication changes in the perinatal period, the highest proportion (57%) occurred pre-partum, with fewer changes in each trimester, as pregnancy progressed. Patients who received pre-pregnancy counselling were more likely to have pre-pregnancy medication adjustments and were more likely to utilize a DMARD or biologic during pregnancy. The survey was completed by 19 respondents. Fourteen women (74%) reported that they would consider ARD use in pregnancy with the highest degree of comfort reported for DMARDs (N=16, 84%), compared to steroids (N=3, 16%), non-steroidal anti-inflammatory drugs (N=6, 32%) and biologics (N=2, 11%).  Fifteen participants (79%) felt that their questions were adequately answered by health care providers with the majority (79%) describing their rheumatologist as their primary information source.  Most patients believed that information received from healthcare providers was helpful (N=15, 79%) and felt that they were provided adequate resources to inform decisions about medication use in pregnancy (N=11, 58%).

Conclusion: While the majority of women with rheumatic diseases in our cohort continued on ARD therapy during pregnancy, most survey respondents reported discomfort with use of steroids, NSAIDs, biologics and DMARDs, despite evidence of their safety in recent literature. This discrepancy between patient perspectives and available evidence is important to consider when counseling patients on ARD use in pregnancy. Survey respondents relied on their rheumatologist as their primary information source, highlighting the important role specialists can play in informing patient perspectives surrounding ARD use in pregnancy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-modifying-anti-rheumatic-drug-and-biologic-therapy-in-pregnancy-a-single-center-mixed-methods-study/