820: “You can't get pregnant:” Contraceptive counseling by non-gynecologic specialties

Abstract

Unintended pregnancies can be life-threatening for women with complex medical conditions, yet MFMs typically do not meet the patient until after conception. We sought to better understand the contraceptive counseling provided by non-gynecologic specialists who care for medically complex women. Providers across 10 non-gynecologic specialties at a single tertiary center in 2016-2017 completed an anonymous survey. The survey assessed provider demographics, counseling rates, and comfort with counseling about contraception and pregnancy risks. We then performed a retrospective cohort study to evaluate the extent of contraceptive counseling women with 20 high-risk comorbidities received. We selected comorbidities that are frequently encountered (e.g. diabetes, hypertension), associated with high morbidity (e.g. pulmonary hypertension), or put a woman at high risk of exposure to teratogenic medications (e.g. acne, lupus). We compared comorbidities using low-, moderate-, and high-maternal morbidity classifications. We considered teratogenic medications to be those previously classified as FDA category X. Of 200 providers approached, 158 responded (79%). Of respondents, 77% felt that it was the responsibility of all providers (primary care, gynecologist, and specialist) to counsel the patient about the risks of pregnancy; 60% felt that these same providers were responsible for counseling about contraceptive options. Over 40% of respondents reported providing contraceptive counseling "always” or "most of the time,” and over 35% reported offering contraception "always” or "most of the time.” Additionally, 40% of respondents reported counseling women about the risks of pregnancy; however, contraception was documented for only 36% of all women and recommended to ≤5% of women with high-risk medical conditions or taking a teratogenic medication. The risks of pregnancy or medication were rarely documented. While non-gynecologic specialists feel that contraceptive counseling is their responsibility, they do not routinely document counseling nor refer them to a gynecologist. OB and MFMs must provide more outreach to subspecialists who care for these women to help prevent unintended pregnancies in women at high risk of perinatal morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)