Background/Purpose: Systemic lupus erythematosus (SLE) primarily affects women of childbearing age, with a higher burden in non-Caucasian populations. Due to the increased risk of adverse pregnancy outcomes in SLE, especially among non-Caucasian patients, it is essential for rheumatologists to engage patients in reproductive health discussions. Our study aims to gain insight into the conversations surrounding reproductive health between rheumatology providers and a primarily Hispanic SLE population, with a focus on disparities between English-speaking and Spanish-speaking populations.

Methods: A 28-question survey based on the American College of Rheumatology 2020 Reproductive Health Guideline was developed, covering contraception, preconception counseling, and pertinent peri-partum issues. The survey was offered in either English or Spanish to female patients with SLE between the ages of 18 – 50, at a safety-net outpatient rheumatology clinic in urban Los Angeles. Data were presented using frequency (%) or median (IQR) and evaluated using Fisher’s exact or Wilcoxon rank sum test, as appropriate.

Results: From March 15 2023, to May 16 2023, 61 surveys were collected. Response rate was 92%. Participants identified as Hispanic (84%), with 71% expressing an English-language preference (Table 1). For all respondents who reported being sexually active with a male partner, 29% denied use of any kind of birth control, and only 25% noted effective contraception (long-acting reversible contraception or sterilization) (Table 1). Approximately 60% of all patients who sought pregnancy after SLE diagnosis took hydroxychloroquine (Table 2). However, while 73% of English-survey respondents noted that a rheumatologist advised them to be on hydroxychloroquine during the pre-conception/pregnancy period, only 60% of Spanish-speaking individuals were given the same counsel (Table 2). English-language respondents reported a significantly higher frequency of conversations in the past one year regarding contraception and pregnancy planning compared to Spanish-speaking respondents (72% vs. 33% and 76% vs. 39%, respectively; Table 2).

Conclusion: This study highlights the importance of thorough reproductive health discussions for patients with SLE, especially in a primarily Hispanic population. For a population known to have high rates of teratogenic medication use and/or poorly controlled disease activity, suboptimal contraception was common. Some disparities between the English and Spanish speaking population include the English-speaking population had a higher rate of conversations surrounding contraception and pregnancy in the past one year, compared to the Spanish speaking patients. This suggests potential barriers in the Spanish-speaking patient population. Hydroxychloroquine use during pregnancy or for those trying to conceive was low, although only patients who ever attempted to conceive or had a pregnancy after SLE diagnosis answered this question. Further research should explore ways of optimizing reproductive health conversations, especially regarding hydroxychloroquine and contraception use, in the management of Hispanic SLE populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reproductive-health-discussions-between-rheumatology-providers-and-systemic-lupus-erythematosus-patients-a-survey-of-english-and-spanish-speaking-patients/