WHEP Scholar Meagan Clark
Drexel University College of Medicine, Class of 2021

Clinicians treating women with rheumatologic disorders must be aware of risks and complications surrounding fertility, contraception and pregnancy in their premenopausal patients. Many women discontinue immunomodulatory agents before or during pregnancy either due to a lack of research on the safety of the drug, a lack of understanding by the physician on current protocol or a lack of communication to or education of the patient by the physician. In addition, a large proportion of premenopausal women with rheumatologic disease report a lack of contraceptive counseling and have engaged in sexual practices with a significant risk of unintended pregnancy. Using teratogenic immunomodulatory agents and active rheumatic disease are both associated with adverse pregnancy outcomes and need to be monitored in all premenopausal women at risk of pregnancy.

Using a short paper survey questionnaire, we examined awareness of effective contraception, medication usage and the impact of rheumatic disease on fertility and pregnancy among premenopausal women of different ages, races and socioeconomic backgrounds with a diagnosis of systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s syndrome, mixed connective tissue disease, vasculitis, scleroderma or spondyloarthropathy. We also determined whether patients had received previous counseling from their physicians regarding these issues.

Although 68.4% of participants demonstrated awareness of the risk of pregnancy in active rheumatic disease, 30% reported not receiving counseling around these issues in addition to potentially inappropriate understanding of the relationship between their therapy and pregnancy. Only 59% of women sexually active with men reported using contraception. More than half of participants at risk of unintended pregnancy were also taking methotrexate, Cellcept, cyclophosphamide or Benlysta and were therefore at an increased risk for adverse pregnancy outcomes. There is a real need to educate and engage patients to actively participate in their care and subsequently increase their awareness around fertility and contraception issues.