Medical conditions, pregnancy perspectives and contraceptive decision-making among young people: an exploratory, qualitative analysis

Abstract

Objective: To explore perspectives on family planning among young people who perceive they are infertile or will have difficulty carrying a pregnancy to term owing to medical conditions or procedures. Methods: This exploratory analysis examined pregnancy plans and contraceptive behavior among 12 young adults with a diagnosed medical condition or who had undergone a medical procedure associated with impaired fertility, and who had discussed fertility with a healthcare provider. We utilized data from a larger study investigating prospective pregnancy intentions and plans among 50 young (ages 18-24) women and their male partners (n=100). Results: Medical conditions included endometriosis, polycystic ovary syndrome, and lupus. For some, medical conditions/procedures led to use of no or less effective contraception, as perceived risk for pregnancy was low, though seven participants had previously experienced pregnancies. Participants also described how medical conditions altered their timelines for pregnancy and overall desire for children; for example, one participant described continuing an unplanned pregnancy because she feared it would be her only chance to parent. Conclusion: This exploratory analysis suggests that among young people, medical issues perceived to affect fertility and pregnancy may influence pregnancy planning and contraceptive behavior. Young people may lack knowledge about fertility and the impact of a medical condition; thus it is critical that providers clarify the difference between anticipated difficulty conceiving and complete infertility. Tailored contraceptive care is needed for young adults with medical conditions that may affect fertility to ensure they have the necessary information to make informed family planning decisions.

Reproductive health needs of adolescent and young adult women with pediatric rheumatic diseases

“…In spite of the unmet facet of clinical care reported almost two decades ago [16], AYAs and their parents continue to report dissatisfaction as to how reproductive health is addressed in pediatric rheumatology clinics [17]. Our findings mirror published literature reporting a dearth of reproductive health information available to rheumatology patients of child-bearing age [5,6,18], and young adults with other chronic diseases [19]. In other studies, women reported making key decisions about reproductive health based on misinformation, anxiety, and fear versus medical input and reliable resources [6,7].…”

“Walking into the unknown…” key challenges of pregnancy and early parenting with inflammatory arthritis: a systematic review and thematic synthesis of qualitative studies

“… ● ○ ● Clowse et al [ 26 ] 2019 USA SLE Patient Provider 15 32 (21, 25 range) 44 (28, 67 range) 100 63 Focus group interviews, qualitative analysis To identify factors influencing the management of SLE during pregnancy among community and university rheumatologists. ● ○ ● Gomez et al [ 27 ] 2019 USA SLE, other c Patient 12 d 21.5 (1.7 SD) 83 Individual semi-structured interviews, thematic analysis To explore perspectives of family planning among young people who believe they are infertile or will have challenges carrying a pregnancy to term due to medical conditions or procedures. ● ○ ○ Phuti et al [ 28 ] 2019 South Africa SLE Patient 25 31 (22, 45 range) 100 Individual interview, thematic analysis To explore living experiences, perceptions, and unmet needs of South African patients with SLE.…”

“…I did, which helped immensely because I was unable to continue the biologic medication, I was unable to work and had to rely on my savings to pay for medicine, doctors, etc.’ [ 20 ] [One participant], who had been pregnant once, described openness in her pregnancy timeline because of her Lupus diagnosis: ‘Yeah, so if I’m like 26, and they are like, yeah, you are in remission, and I’m in a good place with everything else, I figure that might be the time. So I would not want to wait necessarily in case I get sick again.’ Although [she] would prefer to wait until age 27 or 28 to become pregnant, she also recognized the need for flexibility in those plans because she could not predict the status of her lupus […] Because of this, she said, ‘Family planning for me would probably go around when I’m in remission.’ [ 27 ] Prioritizing the needs of mother and child • Trade-offs between pregnancy/breastfeeding desires and potential harms of IA management • Self-advocacy Another member described why, even after discussing the risks of pregnancy and the appropriate medications to take, women may move forward with their own pregnancy plan even against their rheumatologist’s recommendation, ‘I know [getting pregnant] is not the best for me…but I want to get pregnant.’ [ 26 ] Experiencing pregnancy and parenthood Trying to conceive • Challenges with fertility, disease activity, and conception • Emotional impact of conception with IA ‘Two years, no child. Some of them [in-laws] are going to say, “You must take this one out, this is a barren [woman].”’ [ 28 ] ‘With the rheumatologist advising certain medication-free timeframes before conception and the obstetrician/gynaecologist recommending surest ways to conceive on the first try, I felt like a science experiment for a while.’ [ 20 ] Experiencing disease activity during pregnancy & post-partum • Perinatal flares and pregnancy complications • Perinatal medication use ‘It was the last four weeks of my pregnancy that I finally had some relief from RA but within a week of giving birth again I was in severe pain and not being able to lift my baby’.…”

“…Making decisions about using medications [ 4 , 5 , 13 , 14 , 20 , 22 , 26 , 27 , 29 ] and breastfeeding [ 5 , 20 ] were closely intertwined with reproductive decisions. Patients reported desiring more information about medication safety related to fertility, pregnancy, and breastfeeding [ 4 , 5 , 20 , 29 ], consequences of changing or discontinuing medications on disease activity and subsequent medication efficacy [ 4 , 5 , 20 , 29 ], alternative or adjunct (e.g.…”

lncRNA H19 acts as a ceRNA to regulate the expression of CTGF by targeting miR-19b in polycystic ovary syndrome

“…PCOS is a common reproductive endocrine disease in gynecology. Anovulatory infertility caused by PCOS is a serious problem for women of childbearing age (12). PCOS not only affects female fertility but also affects multiple organs in the body (13,14).…”