Background/Purpose: In June 2022, the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health removed the federal constitutional right to abortion, returning abortion policy to individual states. Approximately one-third of states have since banned or planned to greatly restrict abortion access. We distributed a confidential online survey to a sample of U.S.-based rheumatologists to learn how the Dobbs decision might affect clinical practice around teratogen prescribing, abortion referrals, and perceived vulnerability to criminalization.

Methods: This study was designated as exempt by the University of Pittsburgh Institutional Review Board. QR codes to the survey were disseminated in November 2022: 1) at a plenary session about reproductive health at the American College of Rheumatology (ACR) national meeting; 2) via Twitter by study investigators during the ACR national meeting. Results were analyzed by descriptive statistics or chi-square tests, which compared responses by practice in abortion-restricted or protected states.

Results: Most respondents (N=152) identified as female (80.3%), practiced in academic settings (76.3%), and were in their early careers (fellows: 13.2%, < 10 years of independent practice: 47.4%). Approximately 47% of respondents practiced in abortion-restricted states. Half of respondents reported that one or more of their patients had ever become pregnant while using a teratogen (e.g., methotrexate, mycophenolate), and 34% had ever recommended abortion to a patient before Dobbs. Rheumatologists in abortion-restricted states were more comfortable referring a patient for abortion without fear of reprisal prior to Dobbs than post-Dobbs (83.1% and 34.8%, respectively; p< 0.001). Rheumatologists in abortion-restricted vs protected states were marginally more likely to report that they had changed or planned to change how often they prescribed methotrexate (13.0% vs 5.3%, p=0.146) and/or mycophenolate (8.7% vs 1.32%, p=0.05) to reproductive-age patients.

Conclusion: Our results suggest that rheumatologists’ prescribing patterns may change in the context of the nationwide abortion restriction, particularly in abortion-restricted states; reproductive-age females with rheumatic diseases may therefore have less access to evidence-based treatments such as mycophenolate and methotrexate [2-5]. Limitations of the current study include uncertain representativeness of the sample: the response rate cannot be calculated due to social media dissemination, and rheumatologists who had more interest in reproductive health issues may have been more likely to respond to the survey. Nonetheless, our findings underscore an urgent need for data to inform a concerted public health response that protects the health and well-being of females with rheumatic diseases.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effects-of-post-dobbs-abortion-policy-on-rheumatology-clinical-practice-a-survey-of-rheumatologists/