Family planning and pregnancy issues for women with systemic inflammatory diseases: patient and physician perspectives

Abstract

ObjectivesTo identify family planning and pregnancy (FPP) issues for female patients of childbearing age living with a chronic inflammatory disease and to assess whether current clinical practice routinely provides adequate support to alleviate these concerns.SettingMultinational survey and an analysis of online patient activity.ParticipantsPremenopausal women (aged 20–45 years; N=969) were surveyed in the USA, the UK, Germany, France, Italy and Spain. Rheumatologists were surveyed in Germany (N=50), France (N=50), Italy (N=50) and the USA (N=100), and gastroenterologists were also surveyed in the USA (N=100).Primary and secondary outcome measuresTwo online surveys were undertaken to identify FPP issues for physicians and patients. The surveys examined the frequency of dialogue on these topics between physicians and patients, alongside assessment of patient satisfaction regarding these conversations. Online analysis identified key themes for patient discussion outside their doctors’ office/clinic/surgery.Results32–56% of physicians spontaneously reported having talked about FPP with their female patients of childbearing age. When prompted, the majority of rheumatologists (74–92%) and gastroenterologists (74%) reported having discussed conception/pregnancy with female patients; however, less than half reported consulting their patient's treating general practitioner/gynaecologist about these topics. The majority of patients reported their FPP-related concerns are not adequately addressed/settled during their medical appointments. Furthermore, only 30–40% of patients considered advice/information to be consistent across multiple healthcare professionals. Key online FPP-related patient discussions included disease state, adverse effects, treatment, switch behaviour and wash-out requirements.ConclusionsFemale patients who live with chronic inflammatory disease have important FPP concerns. The majority of patients, however, do not feel that their FPP concerns are adequately addressed in current clinical practice and report that they receive inconsistent advice from the various healthcare professionals who manage different aspects of their care. There is a clear need for provision of up-to-date and consistent information/support to female patients.

Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study

“…For example, in several studies, young women with rheumatic diseases reported that they rarely received contraceptive counseling, even when starting an antirheumatic drug with fetotoxic potential . A survey including rheumatologists indicated that only 32–56% of these physicians had recently discussed family planning with female patients . However, no prior studies to our knowledge have explored rheumatologists’ in‐depth perspectives regarding FPCC for young, female patients.…”

Who receives contraception counseling when starting new lupus medications? The potential roles of race, ethnicity, disease activity, and quality of communication

“…A survey of physicians treating women with systemic inflammatory diseases found that only 32 – 56% of physicians reported having talked about family planning and pregnancy with their female patients of reproductive age. (8) Most patients reported that their family planning and pregnancy concerns were not adequately addressed or settled during their appointments. (8) When discussion does occur patients often report inconsistency in the advice they receive from different providers.…”

“…(8) When discussion does occur patients often report inconsistency in the advice they receive from different providers. (8,9)…”

Pregnancy Outcomes After Exposure to Certolizumab Pegol

“…For women affected by chronic inflammatory diseases, such as rheumatoid arthritis (RA), axial spondyloarthritis (SpA), psoriatic arthritis (PsA), and Crohn's disease (CD), disease onset, diagnosis, and initiation of treatment increasingly overlap with peak reproductive age (1,2). For many of these patients, disease activity during pregnancy requires effective management to maintain maternal health and ensure optimal fetal outcomes.…”