Background/Purpose: Reproductive aged women with rheumatic diseases are often prescribed teratogenic medications. These medications pose a serious threat to the mother and fetus. Rates of contraceptive use and unintended pregnancy among teen girls taking teratogenic medications are not well described.

Methods: Medicaid claims data from 12 de-identified US states, between 2013-2015, was used to create an inception cohort of teen girls aged 15-19 prescribed teratogenic medications. Teens received a prescription for at least 1 of 8 teratogenic medications used in the management of pediatric rheumatic disease. Teratogenic medications were defined as FDA category D or X. We identified teratogenic medications commonly prescribed to teens for a variety of conditions: cyclophosphamide, enalapril, leflunomide, lisinopril, losartan, methotrexate and mycophenolate. Cyclosporine was also included (category C). Teens entered the cohort upon receiving a teratogenic medication prescription and were followed for 12 months or until the end of 2015. Outcome of interest was pregnancy. Covariate of interest was contraceptive use, which was evaluated by prescription claims for any type of prescription contraceptive. We identified a sub-group of teens with rheumatic diseases, as determined by outpatient visits with at least two diagnostic codes consistent with a rheumatic disease. Data were analyzed using SAS version 9.4.

Results: 4853 teen girls aged 15-19 met criteria for inclusion, 36.6% Black, 4.8% Hispanic, 13.6% other and 45.1% White. There were 368 pregnancies comprising 7.5% of the cohort, 26 resulted in abortion. Pregnancy by race was statistically significant (7.6% Blacks, 9.1% Hispanics, 4.7% other, and 8.3% Whites, p<0.0185). Of the total pregnancies, 50% occurred in girls aged 15-17, with 19 year olds having the most pregnancies. In pregnant teens, exposure days to teratogenic medications ranged from 117 days to 326 days, with 19 year olds having the shortest time on teratogenic medications prior to pregnancy. In this cohort, 52% were prescribed contraception during the analysis period. Contraception by race was statistically significant (50.5% Blacks, 37.9% Hispanics, 44.8% other, and 58.1% of Whites, p<0.001). In teens with unintended pregnancies, 75% did not receive a prescription for contraception prior to pregnancy. Approximately 10% of this cohort was identified as having a rheumatic disease, with SLE being the largest percentage (70%).

Conclusion: Contraceptive prescriptions in teens on teratogenic medications were low and a significant number of teens had unintended pregnancies. While only 10% of the individuals were identified as having a rheumatic disease based on ICD-9 coding, this number is likely higher as we were very specific in the ICD-9 codes chosen. Teen pregnancy is a serious population health risk especially in patients with chronic rheumatic disease on teratogenic medications. Future analyses will compare contraception and pregnancy rates in our cohort to teens not on teratogenic medications. This analysis highlights the importance of reproductive health education including improved access to contraception for patients on teratogenic medications.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/rates-of-contraceptive-use-and-unintended-pregnancy-in-teen-girls-prescribed-teratogenic-medications/