Contraceptive counseling and use among women with systemic lupus erythematosus: A gap in health care quality?

Abstract

Objectives Disease activity and medication use can complicate pregnancies in SLE. We therefore examined contraceptive counseling and use among women in the University of California, San Francisco Lupus Outcomes Study. Methods In 2008, we queried participants regarding their pregnancy intentions, contraceptive use, and receipt of contraceptive counseling. Premenopausal women <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. Results 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 contraceptives (IUDs) were used by 13%. Women using potentially teratogenic medications were no more likely to have received contraceptive counseling, to use contraception consistently, or to use more effective contraceptives. 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. Conclusions 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 provision of contraceptive services to women with SLE.

Pregnancy implications for systemic lupus erythematosus and the antiphospholipid syndrome

“…Several conditions may require an effective contraception: early stage of the disease, very active disease, severe organ involvement or damage, use of embryotoxic/fetotoxic drugs. Therefore, contraceptive counselling is essential in the rheumatologic practice, but in the "real life" most women do not receive any information about this issue [110,111]. A common misconception among women with SLE is that they "cannot use birth control", since the "classical" oestrogen-containing pill is generally contraindicated.…”

Receipt of Prescription Contraception by Commercially Insured Women With Chronic Medical Conditions

“…(8–13) Prior studies examining the relationship between chronic conditions and contraceptive use have yielded inconsistent results(1, 14–18) and have been limited by their use of cross-sectional, retrospective(14) and self-reported data(14, 16, 17). Some studies focusing on single diseases, such as diabetes mellitus, have reported lower rates of receipt of contraceptive counseling, prescriptions, or services among women with these conditions.…”

Quality of care in systemic lupus erythematosus: the association between process and outcome measures in the Lupus Outcomes Study

“…Using data from the LOS, we found that individuals with SLE received approximately 65% of services recommended in SLE process measures 4. Studies examining osteoporosis prevention and treatment, cardiovascular risk screening, reproductive healthcare, immunisations and also provision of recommended SLE therapies have identified gaps in care for each of these areas 5–7 22 23. Patients who have historically had a higher risk for poor outcomes in SLE, including individuals with low socioeconomic status, were more likely to receive lower quality of care across many of these studies, an effect that seems at least partially mediated by health system characteristics, such as insurance or the systems of care 4.…”