Background/Purpose: Contraception helps reproductive-age women with rheumatic diseases to avoid or plan pregnancies so that disease quiescence on safe medications may first be achieved. However, little is known about contraceptive usage among these women. This study examines the prevalence and predictors of prescription contraception among women receiving rheumatologic care from a large, multi-site health care system in Pittsburgh, Pennsylvania.

Methods: We examined administrative data for women aged 18-50 years with ≥ 1 of 18 rheumatic diagnoses based on ICD-9 codes, and ≥ 2 visits to a rheumatology outpatient clinic between years 2013 and 2014. Prescription contraceptive methods were identified and categorized by highest level of efficacy. Highly-effective contraceptive methods included female sterilization, intrauterine devices, and subdermal implants; records of these procedures were abstracted from years 2003-2014. Moderately-effective methods included pills, rings, patches, and injections. Patients’ medications were categorized by FDA pregnancy risk classes (Class A/B/C medications: lower fetal risk, Class D/X medications: higher fetal risk). Logistic regression was used to evaluate associations of 1) any prescription contraception or 2) use of highest efficacy contraception, adjusting for frequency of visits to health care providers, medications by FDA pregnancy risk class, and demographic variables (age, race, marital status). Women with prior record of hysterectomies (n=97) were excluded from analyses.

Results: In our sample of 2631 women, most were married (52.6%) and White (82.2%), with mean age of 39.6 (S.D. 7.7). Antiphospholipid antibody syndrome (35.5%), rheumatoid arthritis (23.3%), systemic lupus erythematosus (19.4%), and Sjogren’s Syndrome (18.8%) were the most common diagnoses. Women had a median of 3 rheumatology visits, but most had no documented visits with primary care providers (PCP) (59.8%) or gynecologists (68.3%) over the 2-year study timeframe. Contraception was prescribed to 32.6% of women, and 8.8% used highly-effective methods. Class D or X medications were prescribed to 71.2% of women. Younger age (aOR:0.9; 95%CI:0.92-0.96), ≥1 visits with a PCP (aOR:1.8; 95%CI:1.6-2.2) or gynecologist (aOR:3.6; 95%CI:3.0-4.3), or ≥ 2 rheumatology visits (aOR:1.2; 95%CI:1.0-1.4), were associated with prescription contraception. Fetotoxic versus safer medication prescription was not associated with overall prescription contraception, but was associated with prescription of highly-effective contraception (aOR:2.1; 95%CI:1.4-3.0), as was younger age (aOR:0.97; 95%CI:0.95-0.99), and at least 1 visit with a PCP (aOR:1.6; 95%CI:1.2-2.1) or gynecologist (aOR:3.6; 95%CI:2.7-4.8).

Conclusion: Overall prescription contraceptive prevalence was low in this sample. Care from PCPs or gynecologists enhanced the prescription of contraception– particularly with highly-effective methods. Increasing referrals to these women’s health providers is one approach to improving contraceptive care for reproductive-age women with rheumatic diseases.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-contraceptive-use-among-reproductive-age-women-with-rheumatic-diseases/