Improving contraceptive access and use among women on teratogenic medications in a community-based psychiatry clinic

Background Systemic Lupus Erythematosus (SLE) is an autoimmune disease that primarily affects women of reproductive age. Disease activity and medication use can complicate pregnancies in SLE, due to the disease itself and/or exposure to teratogenic medications. Therefore, these patients should be counseled and are candidates for highly effective contraceptive methods. Objectives To examine contraceptive counseling and use among SLE patients attending our Rheumatology Department. Methods Cross-sectional study in which women aged 15-50 followed in our Rheumatology Centre with SLE diagnosis completed a researcher-administered survey. Premenopausal women who were sexually active were considered at risk of pregnancy. We compared self-reported rates of contraceptive counseling and use, stratified by treatment with teratogenic medications, and by history of thrombosis or antiphospholipid antibodies (aPL). The statistical analysis was performed using SPSS 23.0, and p Results 95 women were interviewed, of these, 60 were considered to be at risk for unplanned pregnancy. Their median age was 36 years (range 17-48), and median disease duration 9.9 years (range 0.25-37.0). 85% were aware of the complications associated with pregnancy in their medical condition and 73.3% had received contraceptive counseling. Fifty-six patients (93.3%) reported consistent contraceptive use. Younger patients were more likely to have received contraceptive counseling (35.0 [17-46] years versus 42.5 [20-48] years, p=0.021). Counseling was more frequently reported by patients with higher educational level (p=0.026). Those who were counseled were using more effective contraceptives and in logistic regression contraceptive counseling was a predictor of highly effective contraception use (OR=13.1, p Women using teratogenic medications or with a history of thrombosis were no more likely to have received contraceptive counseling or to use more effective contraceptives. Those with positive aPL were using more effective contraceptives (p=0.024). In our model, having a high school degree and positive lupus anticoagulant predicted contraceptive counseling (OR=12.6, p=0.041; OR=3.1, p=0.02, respectively). Conclusion This study highlights the importance of contraceptive counseling in SLE patients at risk for unplanned pregnancy. A multidisciplinary team including rheumatologists, gynecologists and family phsycians is needed to improve the education and provision of adequate contraceptive counseling to these women.

Systemic lupus erythematosus (SLE) and inflammatory arthritis disproportionately affect reproductive-age Hispanic women, who experience more severe disease and worse outcomes. Certain factors may contribute to disparities in reproductive health counseling. This survey-based study examined the association between reproductive health counseling and contraceptive use, considering a variety of demographics and teratogenic medication use in a predominantly Hispanic population in urban Los Angeles. An anonymous survey, based on the 2020 American College of Rheumatology Reproductive Health Guideline, was administered to 304 female patients of childbearing age with SLE, rheumatoid arthritis (RA), or juvenile idiopathic arthritis (JIA). Analyses included two-sample t-tests, Pearson's chi-square test, multivariable logistic regression, and Fisher's exact tests, with significance set at P ≤0.05. Of 304 patients, English speakers were significantly more likely to receive contraception counseling than Spanish speakers (odds ratio [OR] 3.36; 95% confidence interval [CI] 1.52-7.40; P < 0.01). Older age was associated with lower odds of receiving counseling (OR 0.95; 95% CI 0.91-0.98; P = 0.01). Among those on teratogenic medications not desiring pregnancy, contraception counseling was linked to higher odds of using long-acting reversible contraception (OR 5.12; 95% CI 1.26-20.71; P = 0.02). Younger patients, those with SLE (vs RA or JIA), and English speakers had higher odds of perceiving their physician as knowledgeable about reproductive health (all P < 0.05). Reproductive health counseling was inadequate for Spanish-speaking and older patients. However, reproductive health counseling was positively associated with effective contraception use among patients on teratogenic medications. Clinicians should be aware of these disparities and the potential benefit of counseling to improve highly effective contraception use.

To examine the frequency of and associations among contraception counseling, contraception use, and the use of teratogenic medications in women of child-bearing age from the Hispanic Los Angeles systemic lupus erythematosus (SLE) population. A 28-Question Anonymous Survey, Based on the 2020 American College of Rheumatology Reproductive Health Guideline, Was Distributed to 151 Female SLE Patients of Child-Bearing Age in the Outpatient Setting. Pearson χ2 Test, Fisher Exact Test, and Wilcoxon Rank Sum Test Were Used, with Multivariable Analysis Conducted Via Logistic Regression. Contraception counseling significantly increased the likelihood of contraception use among sexually active patients on teratogenic medications (P = 0.009). However, no significant difference was found in the use of effective/highly effective contraception methods between patients on teratogenic medications and those not on them (P = 0.07). Spanish-speaking patients reported significantly less counseling in the past year compared with English-speaking patients (34.9% vs. 77.2%, P < 0.01), even after adjusting for age. Many patients with SLE on teratogenic medications do not use appropriate contraception. Among this high-risk Hispanic SLE population, contraception counseling was associated with increased contraception use. However, Spanish-speaking patients reported lower rates of counseling compared with their English-speaking counterparts, highlighting a disparity that warrants further investigation.

Disease activity and medication use can complicate pregnancies in patients with systemic lupus erythematosus (SLE). We therefore examined contraceptive counseling and use among women in the University of California, San Francisco Lupus Outcomes Study. In 2008, we queried participants regarding their pregnancy intentions, contraceptive use, and receipt of contraceptive counseling. Premenopausal women age <45 years who were sexually active with men were considered at risk of pregnancy. We compared self-reported rates of contraceptive counseling and use stratified by treatment with teratogenic medications and by history of thrombosis or antiphospholipid antibodies (aPL), using chi-square tests. We used logistic regression models to examine predictors of contraceptive counseling and use. Among 206 women, 86 were at risk for unplanned pregnancy. Most (59%) had not received contraceptive counseling in the last year, 22% reported inconsistent contraceptive use, and 53% depended solely on barrier methods. Intrauterine device contraceptives (IUDs) were used by 13%. Women using potentially teratogenic medications were no more likely to have received contraceptive counseling, to have used contraception consistently, or to have used more effective contraceptives. A history of thrombosis or aPL did not account for low rates of hormonal methods. Four women with a history of thrombosis or aPL were using estrogen-containing contraceptives. Most women at risk for unplanned pregnancy reported no contraceptive counseling in the past year, despite common use of potentially teratogenic medications. Many relied upon contraceptive methods with high failure rates; few used IUDs. Some were inappropriately using estrogen-containing contraceptives. These findings suggest the need to improve the provision of contraceptive services to women with SLE.

Contraceptive use and counseling in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease of uncertain aetiology that can affect multiple organ systems. The disease is more prevalent in women, with a female:male ratio of about...

Teratogenic medications are often prescribed to women of childbearing age with autoimmune diseases. Literature suggests that appropriate use of contraception among these women is low, potentially resulting in high-risk unintended...

BackgroundSystemic Lupus Erythematosus (SLE) is a disease that primarily affects women of reproductive ages. Unplanned pregnancy in women with SLE can have various complications both for the child and the...

IntroductionWomen with rheumatic heart disease (RHD) face high risks during pregnancy due to hemodynamic stress and teratogenic medications. Appropriate contraceptive use is therefore critical, yet little is known about utilization patterns and lived experiences among this population in Uganda.MethodsWe conducted a mixed-methods study at Uganda Heart Institute and Mbarara Regional Referral Hospital. A cross-sectional survey of 84 women with RHD assessed contraceptive use, while in-depth interviews with 13 participants explored lived experiences. Quantitative data were analyzed descriptively, and qualitative data thematically using Van Manen’s existential framework.ResultsStudy found only 25 (29.7%) women reported using contraception, and 40% were using contra-indicated methods. Among those who discontinued, 34.6% cited side effects such as heavy bleeding, weight gain and palpitation. Notably, 69.6% of women on a teratogenic medication were not using contraception. Qualitative findings revealed themes of fear (of side effects and complications), communication gaps with health providers, hopelessness and frustration due to method failure, and ingenuity in coping strategies. These findings highlight limited counseling and high reliance on inappropriate methods, putting women at risk of unplanned and high-risk pregnancies.ConclusionContraceptive utilization among women with RHD in Uganda is low, inconsistent, and often involves unsafe methods. The absence of adequate counseling and reliance on contraindicated options underline the urgent need for multidisciplinary, guideline-based contraceptive counseling and support for women with RHD to prevent unplanned pregnancies and reduce maternal and fetal risks.

Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are two of the most common rheumatologic diseases diagnosed in women. Both SLE and RA frequently start in women of reproductive age and have significant implications for pregnancy. Use of contraceptive methods in these conditions has been controversial in the past due to concerns regarding potential worsening of disease activity, increased risk for cardiovascular complications, or infection with certain methods in the setting of immunosuppressive treatment. The primary risks from use of hormonal contraceptives in women with SLE involve thrombogenic risks, particularly in those women with positive antiphospholipid antibodies. The best available evidence does not indicate a risk of worsening disease activity in women with inactive or stable active SLE who use hormonal contraceptives. Therefore, with the exception of women at increased risk for thrombosis due to the presence of antiphospholipid antibodies, the benefits of contraception outweigh the risks for most women with SLE. All contraceptive methods appear safe for most women with RA, with the exception of use of progestin-only injectables in women with the greatest risk of osteoporosis. Overall, risks of contraceptive use in women with rheumatologic diseases must be weighed against the risks of unplanned pregnancy during a period of severe disease activity or while on teratogenic medications.

The Birds, the Bees, and Inflammatory Bowel Disease: Preconception Care in Inflammatory Bowel Disease.

To describe sexual health behaviors, contraceptive use, and pregnancy risk among hospitalized female adolescents. We conducted a cross-sectional survey of hospitalized female patients aged 14 to 21 years at 2 academic medical centers to assess sexual health behaviors, contraceptive use, contraceptive counseling receipt, and factors associated with pregnancy complications (eg, diabetes, teratogenic exposure). We calculated the validated Pregnancy Risk Index (PRI) (number per 100 who will become pregnant in the next year). Among 177 participants (mean age 16 years, SD 1.5), 75 (43%) were sexually active. At last vaginal sex, 65% reported condom use; 49%, reversible contraception; and 12%, long-acting reversible contraception (LARC). Past-year contraceptive counseling was reported by 73% of sexually active female participants and was associated with increased use of reversible (P = .001) and dual contraception (P = .03) but not LARC (P = .24). The mean PRI among all participants was 4.75. Nearly three-quarters (73%) had a medical comorbidity or teratogenic exposure. Those with teratogenic medication use had the lowest PRI of 0.32 (P < .05), with 88% using reversible contraception and 31% using LARC. Hospitalized female adolescents had a PRI similar to that of adolescents in the general population. However, nearly three-quarters had a medical comorbidity and/or teratogenic exposure, which increased risk for pregnancy complications. Contraceptive counseling was associated with increased reversible and dual contraception use but not LARC use. Efforts to improve comprehensive contraceptive counseling, highlighting LARC, are critically needed in this population.

Teratogenic medications and concurrent contraceptive use in women of childbearing ability with epilepsy.

Background:Contraception is an important area of reproductive health for patients with rheumatic diseases given the potential pregnancy risk associated with active disease, teratogenic medications and disease related damage.Objectives:To describe the...

Background/introductionThis study aimed to survey US servicewomen on their contraceptive access and use during deployment.MethodsBetween June 2016 and July 2017, we conducted a cross-sectional online survey among a convenience sample...