Dr. Birru Talabi underscores the importance of physicians having intentional discussions with their patients about the use of medications during pregnancy.3 This approach, she hopes, will help avoid giving patients the impression that a given medication may be harmful to the fetus. She emphasizes patients should be informed that medications that are pregnancy compatible should be continued during pregnancy. In contrast, medications with known risks of birth defects, such as methotrexate, should be discontinued. The study found this advice is not always given because patients reported that 15% continued to take methotrexate while they were pregnant.
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Know Patient’s Reproductive Goals
Because rheumatologists prescribe drugs that are a risk to pregnancy, such as methotrexate, Dr. Birru Talabi says prescribers should have knowledge about their patient’s reproductive goals. She explains conversations about these goals should be had with all patients with childbearing potential, including those patients who do not identify as female.
Dr. Birru Talabi suggests rheumatologists routinely ask patients about their pregnancy and reproductive goals, noting that “a lot can happen in several months.”
Although she acknowledges that no official recommendations exist for how often these conversations should take place in the practice of rheumatology, she points to the ACR Reproductive Health Guideline that says contraception tailored to the individual patient with emphasis on safety and efficacy should be discussed and encouraged among people who do not wish for pregnancy. Also, in the case of women of reproductive age, contraception and pregnancy planning should be discussed at the initial or an early visit.4
Coordinated Care
The study also found some women with inflammatory arthritis described advice about medication safety as inconsistent between providers, leading the authors to suggest rheumatology patients would benefit from continued coordinated care between their providers. Such coordinated care reassures patients, says Dr. Birru Talabi.
Particularly, she thinks it’s important for rheumatologists—when possible—to coordinate with obstetricians and gynecologists about the messaging around medication use during pregnancy and suggests rheumatologists reach out to the obstetrician/gynecologist community to identify and build relationships with physicians who have an interest in patients with rheumatic disease.
Pre-Pregnancy Guidance
Some patients also appear to receive conflicting advice on contraception safety, says Dr. Birru Talabi. This conflict is a problem because many patients are prescribed drugs with unclear or known fetal risk. She explains the results can be devastating from a clinical perspective if a patient becomes pregnant, especially because women in various parts of the country do not have the option to end a pregnancy. Thus, Dr. Birru Talabi emphasizes rheumatologists must continue to inform women that they are taking a medication with fetal toxicity before they become pregnant.