In the U.S. today, approximately 45% of pregnancies are unintended or unplanned.1 Although this rate is considerably lower than in the past, women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or inflammatory myopathies tend to have better pregnancy outcomes if their disease is well controlled when they conceive.
In addition, women taking certain medications to control their disease, such as methotrexate, mycophenolate or leflunomide, could put their fetus at risk if they have an unexpected pregnancy. In a 2011 study of 206 California women with SLE published in Arthritis Care & Research (AC&R), 59% had received no contraception counseling in the previous year, 22% reported they used contraception inconsistently and 53% solely relied on barrier methods to prevent pregnancy.2 Another survey published in 2016 revealed that 33% of women with SLE did not receive contraception counseling when they started a new medication, and those patients with the highest disease activity were the least likely to receive this counseling.3
Authors of a new paper in AC&R, “Family Planning Counseling for Women With Rheumatic Diseases,” not only highlight the present gaps in counseling for these patients, but also call for rheumatologists to take an active role in this counseling.4 Rheumatologists are uniquely qualified to manage a woman’s disease activity during her pregnancy and understand the risks of common medications, the authors say. Rheumatologists must overcome communication barriers about pregnancy and contraception, and in place of assumptions, ask patients open-ended questions to determine their reproductive goals and plan adequately for pregnancy.
There is work to be done: Only 56% of rheumatologists surveyed in a 2014 study said they routinely offered this counseling to women patients in their childbearing years, the authors note.5
“The consequences of unintended pregnancy can be very different [for] healthy women [than for] women with rheumatic diseases,” says Mehret Birru-Talabi, MD, PhD, assistant professor, Division of Rheumatology and Clinical Immunology at the University of Pittsburgh, and one of the paper’s coauthors. “A healthy woman who has an unintended pregnancy has really good chances of delivering a healthy baby. While many women with rheumatic diseases have successful pregnancies, there are a considerable number of women who experience adverse outcomes.”
When a pregnancy is unplanned and a patient’s disease is poorly controlled at conception, adverse outcomes could include intrauterine growth restriction, preeclampsia or even fetal loss, the authors say. To optimize outcomes, women with rheumatic diseases are advised to plan pregnancy when they’ve had quiescent disease for at least several months while on pregnancy-compatible medications, says Dr. Birru-Talabi.