Contraceptive use among women of reproductive age with rheumatic diseases appears to be low. Efforts are needed to improve contraceptive care and access to reproductive healthcare for these women.


 

Published research suggests that more than two-thirds of women who are of reproductive age in the United States actively use contraception, but few studies have explored use of these treatments among young women with rheumatic diseases. Despite the potential benefits of contraception, results of several surveys of young women with these diseases have demonstrated that few actually received contraceptive counseling, used any contraception, and rarely used highly effective contraceptive methods like subdermal implants and intrauterine devices. It remains unclear to why this occurs.

To address this research gap, Mehret Birru Talabi, MD, PhD, and colleagues had a study published in Arthritis Care & Research that examined the prevalence and predictors of contraception use among reproductive-aged women with a variety of rheumatic diseases. The investigators assessed 2,455 women who had one of 21 possible rheumatic disease diagnoses and at least two outpatient rheumatology visits. Using logistic regression analyses, they evaluated adjusted associations between the use of prescription contraception, use of potentially fetotoxic medications, and visits with rheumatologists, primary care providers (PCPs), and gynecologists.

 

Analyzing the Findings

Results of the analysis showed that only about 32% of women with rheumatic diseases received any prescription contraception, and just 8% used highly effective prescription methods like intrauterine devices, implants, and surgical sterilization. “Our analysis suggests that some women with rheumatic diseases may be at risk for unintended pregnancy,” says Dr. Birru Talabi. “This is particularly concerning among this because many of these women may be at risk for pregnancy complications.”

More than 70% of women in the study took one or more types of potentially fetotoxic medications, which can increase risks for adverse perinatal outcomes. Fetotoxic medication use was not associated with overall use of prescription contraception, but it was linked to a greater likelihood of using highly effective contraceptive methods. “Many women were exposed to potentially fetotoxic medications, but overall, just a minority used prescription contraception,” notes Dr. Birru Talabi.

The study also revealed that, overall, women who saw gynecologists or PCPs were more likely to use prescription contraception (Table). Women who saw gynecologists were also more likely to use highly effective contraceptive methods rather than moderately effective contraception. However, most women had no documentation of a gynecologist or PCP visit over the 2-year study period. In addition, women who had more than two visits to a rheumatologist were no more likely to use prescription contraception than those who had fewer visits in fully adjusted models.

 

Examining the Implications

Findings of the study suggest and urgent and unmet need to enhance patient care, and family planning counseling appears to be warranted for some reproductive-age women with rheumatic diseases. “Gynecologists and PCPs are important resources for delivering contraceptive care, but rheumatologists can also play a role,” Dr. Birru Talabi says. “Rheumatologists should recognize that practice patterns have changed, with many patients no longer seeing PCPs and gynecologists for annual visits. Therefore, some of their highest-risk patients may lack access to a reproductive healthcare provider who can help manage their contraception or other reproductive health needs. The fact that these women may have gaps in contraception care is an important public health message.”

Rheumatologists may help to fill important gaps in care by educating patients on the associations between disease activity, pregnancy, and fetal risks associated with certain rheumatic drugs, according to Dr. Birru Talabi. “In addition, rheumatologists can potentially prescribe emergency contraception and/or partner with other providers to ensure safe contraception prescribing when it is appropriate,” she says. “Rheumatologists can also help bridge gaps in access to reproductive healthcare by referring women with rheumatic diseases to primary care and/or gynecology. It is important for PCPs and gynecologists to also actively screen patients for their interest in avoiding or experiencing a pregnancy and to work with rheumatologists to help patients meet their reproductive goals safely.”

References

Birru Talabi M, Clowse MEB, Blalock SJ, Moreland L, Siripong N, Borrero S. Contraception use among reproductive-age women with rheumatic diseases. Arthritis Care Res (Hoboken). 2018 Aug 14 [Epub ahead of print]. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23724 and at https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.23724?referrer_access_token=15jumUwTdpSK05dZisw-sk4keas67K9QMdWULTWMo8Ok1oMAOaTL5VODyhBHWIbAyCTN2bXExcaMk2m6NsYcTaCJU3GsGEm7gjMZWPlB362zKpPDGCa9N3G2Drf-6CIMUMxxkqT90dFeUOsYUK_SZA%3D%3D.

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