Background/Purpose:

Autoimmune and inflammatory diseases often affect women of reproductive age and can impact pregnancy outcomes. This patient (pt) group has important concerns about family planning and pregnancy (FPP), however little research has been undertaken into whether such concerns are adequately addressed in current clinical practice. The aim was to identify FPP issues for female pts of child-bearing age and to assess whether current clinical practice routinely provides adequate support to alleviate these concerns.

Methods:

Two online surveys were undertaken to identify FPP issues for both pts and physicians. The surveys were designed to gauge whether there is a gap in the communication by examining the frequency of dialogue on these topics between physicians and pts, alongside assessment of pt satisfaction regarding these discussions. Physician survey was designed to elicit both spontaneous (open-ended questions) and prompted (closed questions) responses: rheumatologists were surveyed in Germany (N=50), France (N=50), Italy (N=50) and the USA (N=100) while gastroenterologists were surveyed in the USA (N=100). Pt survey was targeted at premenopausal women (aged 20-45 years of age; N=969) and delivered in USA, UK, Germany, France, Italy and Spain.

Results: 32-56% of physicians spontaneously reported having discussed FPP with their female pts of child-bearing age across all countries surveyed. When prompted, the majority of rheumatologists (74-92%) and gastroenterologists (74%) reported having discussed conception/pregnancy with female pts; however, less than half reported discussing FPP with their pt’s treating GP/gynaecologist.   Even though physicians report discussing FPP with their female pts, the majority of pts report their concerns relating to FPP are not adequately addressed/settled during their medical appointments (Figure 1A); although responses did vary across countries. Furthermore, only 30-40% of pts considered advice/information to be consistent across multiple healthcare professionals (Figure 1B). Female pts receiving medication for their condition were more concerned about FPP than those not receiving medication (63% vs 32%, respectively), and <5% reported discussing FPP when their condition was stable enough to become pregnant.

Conclusion: Female pts who suffer chronic inflammatory disease have important FPP concerns. The majority of pts, however, do not feel that their FPP concerns are adequately addressed in current clinical practice and report that they receive inconsistent advice from the various healthcare professionals who manage different aspects of their care. There is a clear need for provision of up-to-date and consistent information/support to female pts suffering inflammatory diseases, including the key importance of disease control when/before planning pregnancy.