Background/Purpose: Systemic lupus erythematosus (SLE) and primary Sjogren’s Syndrome (SS) are highly associated with anti-SSA (anti-Ro) seropositivity. Anti-SSA autoantibodies may cross the placenta, causing a range of cutaneous and cardiac manifestations in the neonate. Approximately 2% of SSA-positive pregnancies result in complete congenital heart block, which is often fatal. Echocardiographic monitoring and early treatment with hydroxychloroquine may improve outcomes in SSA-positive pregnancies. Published data suggest that the majority of rheumatology clinic patients with the potential for high-risk pregnancies do not receive pre-pregnancy counseling, possibly due to provider anxiety or uncertainty in this area. We examined the rate of documentation of pre-pregnancy counseling in the specific case of SSA seropositivity.

Methods: We performed a cross-sectional study of 213 SSA-seropositive female patients age < 45 at a large, academic Rheumatology clinic. The majority of patients had a diagnosis of SLE or SS. We excluded 40 patients with a history of surgical birth control (e.g., tubal ligation or hysterectomy). For the remaining 173 patients, we manually reviewed electronic medical records to determine whether a discussion about the risks of SSA-seropositive pregnancy had ever been documented. We further ascertained several co-variates, including: lifetime history of normal, healthy pregnancy; lifetime history of spontaneous abortion and gender of the primary rheumatologist

Results: 67 out of 173 patients (39 percent) had documented counseling by a Rheumatologist regarding the risks of SSA-positive pregnancy. 84 patients (49 percent) had a history of at least one pregnancy; 35 of these had a history of at least one spontaneous abortion. . The rate of documented counseling was similar among patients with a primarily female Rheumatologist (39 percent) as compared to a primarily male Rheumatologist (34 percent).

Conclusion: Less than half of SSA-seropositive patients of childbearing potential have documented evidence of relevant pre-pregnancy counseling. Provider gender was not associated with a difference in the rate of counseling. These results corroborate previous data suggesting that high-risk Rheumatology clinic patients may not receive adequate pre-pregnancy counseling. Notably, these findings suggest that pre-pregnancy counseling is also underutilized in the specific instance of SSA seropositivity. Dedicated quality improvement initiatives are needed to increase the rates of SSA-specific pre-pregnancy counseling, as well as to ensure that such counseling is documented appropriately.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/documentation-of-pregnancy-counseling-in-ssa-positive-patients-of-childbearing-potential-a-cross-sectional-study/