Background/Purpose: Guidelines advise rheumatologists to provide contraceptive counseling for all patients with pregnancy potential prescribed teratogenic medications, however, adherence is inconsistent. We assessed the frequency of, and factors associated with, rheumatologists’ documented contraceptive counseling for this group to elucidate opportunities for intervention.

Methods: This single-center retrospective chart review included premenopausal females aged 18-45 seen by a rheumatologist ≥2 times, December 2022-December 2024, with a prescribed teratogenic medication at the most recent visit. We compared patient demographic and clinical variables and rheumatology provider characteristics between patients with and without documented contraceptive counseling. We performed logistic regression to predict receipt of contraceptive counseling, adjusting for age, race, insurance, preferred language, diagnosis, teratogenic medication, and provider gender and experience level.

Results: Of 338 rheumatology female patients aged 18-45 prescribed a teratogen, 107 (31.7%) received contraceptive counseling at their most recent visit. Patients who received vs did not receive counseling were more frequently non-White race (21.6% vs 11.4% Black; 14.7% vs 12.3% Asian; 25.5% vs 19.6% Other; p=0.01), publicly insured (29.0% vs 13.9%, p< 0.01), non-English-speaking (8.4% vs 2.2%, p=0.02), had SLE and/or APS (39.3% vs 21.2%, p< 0.01), and were seen by a rheumatology fellow (25.2% vs 8.2%) or by an attending with < 10 years of experience (42.1% vs 27.3%) (p< 0.01). Overall, 231 (68.3%) patients reported no/least effective contraception (n=121) or had no contraception documentation (n=110) [Table 1]. In multivariable analysis, the odds of receiving contraceptive counseling decreased 5% with each increasing year of age (OR 0.95, 95% CI [0.92-0.99], p=0.01). Counseling was more likely for patients with Black vs White race (OR 2.5, 95% CI [1.09-5.73], p=0.03), SLE and/or APS vs other diagnoses (OR 3.65, 95% CI [1.66-8.04], p< 0.01), and—as compared to those seen by an attending with >10 years’ experience—for patients seen by a rheumatology fellow (OR 5.31, 95% CI [1.82-15.47], p< 0.01) or by an attending with < 10 years’ experience (OR 3.13, 95% CI [1.7-5.77], p< 0.01). Compared to methotrexate use, use of another teratogen was associated with decreased odds of counseling that was not statistically significant (for leflunomide: OR 0.28, 95% CI [0.07-1.07], p=0.06; for mycophenolate: OR 0.48, 95% CI [0.23-1.03], p=0.06; for warfarin: OR 0.19, 95% CI [0.04 – 1.01], p=0.05) [Table 2].

Conclusion: In this study, most reproductive-aged female patients prescribed a teratogenic medication did not have documentation of effective contraception, and less than one-third received contraceptive counseling at their most recent rheumatology visit. Patients with Black race, SLE and/or APS, and those seen by rheumatology providers closer to training were more likely to receive contraceptive counseling. Although documentation may not fully reflect practice, our findings suggest a need for quality improvement interventions to increase contraceptive counseling and consistent documentation for all high-risk rheumatology patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-contraceptive-counseling-by-rheumatologists-for-reproductive-aged-female-patients-prescribed-teratogenic-medications/