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

Abstract

Objective Family planning discussions are an important aspect of medical care for women with systemic lupus erythematosus (SLE) as active disease is a risk factory for poor pregnancy outcomes, and the medications used for treatment can be harmful to the fetus when used during conception and pregnancy. Our objective was to examine the impact of patient perception of quality and type of communication on receiving contraception counseling. Methods Data were derived from patients enrolled in the University of California, San Francisco Lupus Outcomes Study. Subjects participate in yearly structured telephone interview, which included assessment of contraception counseling when starting new medications, and measures of communication and decision-making. Logistic regression was performed to identify predictors of not receiving contraception counseling. Results Of the 68 women included in this analysis, one third did not receive contraception counseling when starting new medications. Older age, white race, depressive symptoms, and higher SLE disease activity were independently associated with not receiving contraception counseling. Participants who did not receive contraception counseling rated their physicians lower in shared decision making communication. Conclusions This study demonstrates a gap in family planning counseling among women with SLE starting new medications. Future studies to address these potential areas of intervention, including education about the need for contraception through menopause, and mechanisms to engage in SDM surrounding contraception are needed to improve quality of care for women with lupus.

Provider perceptions on the management of lupus during pregnancy: barriers to improved care

“…10 It is not surprising that unplanned pregnancy is so common, as 1/3 of women with lupus starting teratogenic medications are given no instructions to avoid conception. 11 The European League Against Rheumatism (EULAR) guidelines for lupus management in pregnancy emphasize controlling lupus through the use of compatible medications, particularly hydroxychloroquine, azathioprine, and prednisone only when needed. 9 They also recommend against the use of rheumatic teratogens.…”

Risk management of teratogenic medicines: A systematic review

“…B. Schwarz, Parisi, Williams, Shevchik, & Hess, 2012;E. B. Schwarz et al, 2007;Stancil et al, 2016;Steinkellner et al, 2010;Teichert et al, 2010;Uuskula et al, 2018;Wieck et al, 2007), while others used patients surveys (Algoblan et al, 2019;Banas et al, 2014;Bell et al, 2002;Boucher & Beaulac-Baillargeon, 2006;Brandenburg et al, 2017;Brinker et al, 2005;Castaneda et al, 2008;Chang et al, 2018;Ferguson et al, 2016;Goyal et al, 2015;Lelubre et al, 2018;Leverenz et al, 2019;Mitchell et al, 1995;Ozyurt & Kaptanoglu, 2015;Rao et al, 2000;E. B. Schwarz, Mattocks, et al, 2013;Shilalukey et al, 1997;Tsur et al, 2008;Valle et al, 1998;Werner et al, 2014;Yazdany et al, 2011), a combination of medical records and patient surveys (Bosak et al, 2019;Entezari-Maleki et al, 2012;Hogan et al, 1988;E.…”

“…Data sharing is not applicable to this article as no new data were created or analyzed in this study. (Bhakta et al, 2015;Brandenburg et al, 2017;Brinker et al, 2005;Castaneda et al, 2008;Cheetham et al, 2006;DiPietro Mager, Mills, & Snelling, 2018;Ferguson et al, 2016;Force et al, 2012;Fritsche et al, 2011;Gotlib et al, 2016;Goyal et al, 2015;Hayward et al, 2016;Landis et al, 2012;Leverenz et al, 2019;Mitchell et al, 1995;Mody, Farala, et al, 2015;Pinheiro et al, 2013;Rao et al, 2000;E. B. Schwarz et al, 2010;E.…”

“…B. Schwarz, Parisi, Williams, et al, 2012;E. B. Schwarz et al, 2007;Stancil et al, 2016;Steinkellner et al, 2010) Isotretinoin 16 (29.1%) (Algoblan et al, 2019;Boucher & Beaulac-Baillargeon, 2006;Brinker et al, 2005;Cheetham et al, 2006;Crijns et al, 2012;Entezari-Maleki et al, 2012;Hogan et al, 1988;Lelubre et al, 2018;Mitchell et al, 1995;Ozyurt & Kaptanoglu, 2015;Pinheiro et al, 2013;Rao et al, 2000;Teichert et al, 2010;Tsur et al, 2008;Uuskula et al, 2018;Werner et al, 2014) Antiepileptic or anticonvulsant medications 5 (9.1%) (Bell et al, 2002;Bhakta et al, 2015;Bosak et al, 2019;Langan et al, 2013;Wieck et al, 2007) Arthritis or lupus medications 4 (7.3%) (Banas et al, 2014;Ferguson et al, 2016;Leverenz et al, 2019;Yazdany et al, 2011) Valproate/valproic acid 4 (7.3%) (Atturu & Odelola, 2015;Gotlib et al, 2016;Mulryan et al, 2018;Paton et al, 2018) Thalidomide or lenalidomide 3 (5.5%) (Brandenburg et al, 2017;Castaneda et al, 2008;Chave et al, 2001) Acitretin 1 (1.8%) (Raguideau et al, 2015) Chemotherapy for breast cancer 1 (1.8%) (Valle et al, 1998) Deferoxamine a...…”

Family Planning Counseling for Women With Rheumatic Diseases

“…Similarly, nearly half of reproductive‐age women with SLE in another survey reported having had unprotected sex, with 23% of respondents having had unprotected sex most of the time, in the prior 3 months . Another survey reported that 33% of women with SLE did not receive contraceptive counseling when starting new medications, and individuals with the highest disease activity were least likely of all patients to receive contraceptive counseling . A study by Chakravarty et al reported that a majority of European and US women with SLE, RA, and inflammatory bowel diseases (IBD) felt that family planning concerns were inadequately addressed by their providers.…”