Background/Purpose: Systemic autoimmune diseases are often treated with medications that have known teratogenic effects or unknown safety profiles in pregnancy. As these diseases frequently affect women of childbearing potential, it is important for rheumatologists to provide reproductive health counseling to patients. While studies have shown variable rates of reproductive health counseling by rheumatology providers, less is known about the effectiveness of that counseling. In this study, we used patient-reported questionnaires to evaluate the effectiveness of prior reproductive health counseling of rheumatology patients.

Methods: Female patients followed at an academic rheumatology outpatient practice were invited to complete on-line questionnaires if they were of childbearing potential (i.e., 18-50 years without surgical sterilization, hysterectomy, or menopause), had an established autoimmune condition, and had no plans for pregnancy in the next year. To assess prior reproductive health counseling, patients were asked if they had ever received contraception counseling or been counseled about the pregnancy risks of their medications by their rheumatologist. Counseling effectiveness was assessed by asking “Do you think you are safe to become pregnant now?” and “If you decided to become pregnant in the future, would you talk to your rheumatologist about those plans?” Demographics, medication use, and contraception use were also collected by questionnaire. Results were compared between women who did vs. did not report prior reproductive health counseling.

Results: One hundred and one patients completed the questionnaire. Seventy-one (70.3%) reported having ever received reproductive health counseling by their rheumatologist. Reproductive health counseling rates were higher in women < 40 years of age (p< 0.01) and in women currently or previously taking teratogenic medications (p=0.01). We found that women who had received reproductive health counseling were less likely to be ‘unsure’ whether they were safe to become pregnant compared to women who did not report prior reproductive health counseling (8.5% vs. 36.7%, p< 0.01). This difference was also present in the subset of 32 women currently taking teratogenic medications (0% vs. 40%, p=0.02) (Table 1). Women who had previously received reproductive health counseling from their rheumatologist were also more likely to report that they would talk to their rheumatologist if they decided to become pregnant in the future (98.6% vs. 83.3%, p< 0.01) (Table 1).

Conclusion: This study demonstrates the significant impact that reproductive health counseling by rheumatologists can have on patient outcomes. Patients who received prior counseling reported greater confidence regarding the safety of a potential pregnancy, which may contribute to improved pregnancy outcomes. Additionally, our findings emphasize the importance of counseling all patients about reproductive health, regardless of their current pregnancy intentions, as those not actively planning pregnancy were still more likely to engage in discussions about future pregnancy plans with their rheumatologist, which can also support better outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-reproductive-health-counseling-for-rheumatology-patients/