Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of reproductive health counseling of women with systemic lupus erythematosus: observational cross-sectional study at an academic lupus clinic

  • Observational Research
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Systemic lupus erythematosus (SLE) affects women of childbearing age. To optimize fetal and maternal outcomes, effective reproductive health counseling is crucial. To analyze the effectiveness of reproductive health counseling in women with SLE and identify gaps in patient educational needs. Cross-sectional study including women aged 18–45 years fulfilling ACR’97 and/or SLICC criteria, followed at an academic lupus clinic. Participants fulfilled a questionnaire evaluating brief obstetric history, knowledge about impact of SLE in pregnancy outcomes, recall of reproductive health counseling, contraception use and reproductive healthcare received. Effectiveness of reproductive health counseling was analyzed, and potential predictors of contraceptive use (age, previous spontaneous abortion, level of knowledge about SLE and reproductive planning) were tested by multiple regression analysis. We enrolled 108 women (mean age: 34.4 ± 7.1 years; mean disease duration: 10.3 ± 7.3 years). 64.8% of the patients recalled receiving information about family planning, and 81% about contraception. Only 38% declared to be well informed about the impact of SLE on pregnancy. In this cohort, 23.2% wanted a pregnancy in the future; the remainder already had the children they wanted or planned a subsequent pregnancy. Contraceptive use was reported by 79.6% of the patients (oral contraceptives by 39.8% and intrauterine device by 20.4%), while 11.1% reported unprotected intercourses. No statistically significant predictors of contraceptive use were identified. In this academic Lupus Clinic, most SLE women of childbearing age received effective reproductive health counseling and use contraceptive methods. Their unmet needs were identified to guide optimization of patient counseling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fischer-Betz R, Specker C (2017) Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome. Best Pract Res Clin Rheumatol 31:397–414. https://doi.org/10.1016/j.berh.2017.09.011

    Article  PubMed  Google Scholar 

  2. Sammaritano LR (2017) Management of systemic lupus erythematosus during pregnancy. Annu Rev Med 68:271–285. https://doi.org/10.1146/annurev-med-042915-102658

    Article  CAS  PubMed  Google Scholar 

  3. Kartoz CR (2015) Reproductive health concerns in women with systemic lupus erythematosus. MCN Am J Matern Child Nurs 40:220–226. https://doi.org/10.1097/NMC.0000000000000145

    Article  PubMed  Google Scholar 

  4. Andreoli L, Bertsias GK, Agmon-Levin N et al (2017) EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 76:476–485. https://doi.org/10.1136/annrheumdis-2016-209770

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Sammaritano LR (2020) Contraception and preconception counseling in women with autoimmune disease. Best Pract Res Clin Obstet Gynaecol 64:11–23. https://doi.org/10.1016/j.bpobgyn.2019.09.003

    Article  PubMed  Google Scholar 

  6. Ostensen M (2017) Preconception counseling. Rheum Dis Clin North Am 43:189–199. https://doi.org/10.1016/j.rdc.2016.12.003

    Article  PubMed  Google Scholar 

  7. Ostensen M (2017) Sexual and reproductive health in rheumatic disease. Nat Rev Rheumatol 13:485–493. https://doi.org/10.1038/nrrheum.2017.102

    Article  CAS  PubMed  Google Scholar 

  8. Talabi MB, Clowse MEB, Schwarz EB, Callegari LS, Moreland L, Borrero S (2018) Family planning counseling for women with rheumatic diseases. Arthritis Care Res (Hoboken) 70:169–174. https://doi.org/10.1002/acr.23267

    Article  Google Scholar 

  9. Lazzaroni MG, Dall’ Ara F, Fredi M et al (2016) A comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus. J Autoimmun 74:106–117. https://doi.org/10.1016/j.jaut.2016.06.016

    Article  PubMed  Google Scholar 

  10. Giles I, Yee C-S, Gordon C (2019) Stratifying management of rheumatic disease for pregnancy and breastfeeding. Nat Rev Rheumatol 15:391–402. https://doi.org/10.1038/s41584-019-0240-8

    Article  PubMed  Google Scholar 

  11. Skorpen CG, Hoeltzenbein M, Tincani A et al (2016) The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis 75:795–810. https://doi.org/10.1136/annrheumdis-2015-208840

    Article  CAS  Google Scholar 

  12. Sammaritano LR, Bermas BL, Chakravarty EE et al (2020) 2020 American college of rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol (Hoboken, NJ) 72:529–556. https://doi.org/10.1002/art.41191

    Article  Google Scholar 

  13. El Miedany Y, Palmer D (2020) Rheumatology-led pregnancy clinic: enhancing the care of women with rheumatic diseases during pregnancy. Clin Rheumatol. https://doi.org/10.1007/s10067-020-05173-6

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kittisiam T, Werawatakul Y, Nanagara R, Wantha O, Werawatakul Y, Nanagara R, Wantha O (2013) Low prevalence of contraceptive counseling at Srinagarind hospital, Thailand among women of reproductive age with systemic lupus erythematosus. Reprod Health 10:21. https://doi.org/10.1186/1742-4755-10-21

    Article  PubMed  PubMed Central  Google Scholar 

  15. Brito MB, Casqueiro JS, Alves FSS et al (2018) Low prevalence of contraceptive use among Brazilian women of reproductive age with systemic lupus erythematosus. J Obstet Gynaecol 38(7):975-978. https://doi.org/10.1080/01443615.2018

    Article  PubMed  Google Scholar 

  16. Dalkilic E, Tufan AN, Oksuz MF et al (2014) Comparing female-based contraceptive methods in patients with systemic lupus erythematosus, rheumatoid arthritis and a healthy population. Int J Rheum Dis 17:653–657. https://doi.org/10.1111/1756-185X.12338

    Article  PubMed  Google Scholar 

  17. Phuti A, Hodkinson B, Tikly M, Schneider M (2020) “The feeling of not being entitled to something”: fertility, pregnancy, and sexuality among women with systemic lupus erythematosus in South Africa. Scand J Rheumatol 49:214–220. https://doi.org/10.1080/03009742.2019.1657492

    Article  CAS  PubMed  Google Scholar 

  18. Ferguson S, Trupin L, Yazdany J, Yeli E, Barton J, Katz P (2016) Who receives contraception counseling when starting new lupus medications? the potential roles of race, ethnicity, disease activity, and quality of communication. Lupus 25:12–17. https://doi.org/10.1177/0961203315596079

    Article  CAS  PubMed  Google Scholar 

  19. Williams J, Xu C, Costenbader K, Bermas B, Pace L, Feldman C (2020) Racial differences in contraception encounters and dispensing among female medicaid beneficiaries with systemic lupus erythematosus. Arthritis Care Res (Hoboken). https://doi.org/10.1002/acr.24346

    Article  Google Scholar 

  20. Andreoli L, Lazzaroni MG, Carini C et al (2019) “Disease knowledge index” and perspectives on reproductive issues: a nationwide study on 398 women with autoimmune rheumatic diseases. Joint Bone Spine 86:475–481. https://doi.org/10.1016/j.jbspin.2018.12.002

    Article  PubMed  Google Scholar 

  21. Talabi MB, Clowse MEB, Blalock S, Moreland L, Siripong N, Borrero S (2019) Contraception use among reproductive-age women with rheumatic diseases. Arthritis Care Res (Hoboken) 71:1132–1140. https://doi.org/10.1002/acr.23724

    Article  Google Scholar 

  22. Østensen M, von Esebeck M, Villiger P (2007) Therapy with immunosuppressive drugs and biological agents and use of contraception in patients with rheumatic disease. J Rheumatol 34:1266–1269

    PubMed  Google Scholar 

  23. Yazdany J, Trupin L, Kaiser R et al (2011) Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality? Arthritis Care Res (Hoboken) 63:358–365. https://doi.org/10.1002/acr.20402

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rheumatology Department, Centro Hospitalar Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal

    Luisa Brites, Stefanie Silva & Luis Inês

  2. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Laura Andreoli

  3. Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy

    Laura Andreoli

  4. School of Health Sciences, University of Beira Interior, Covilhã, Portugal

    Luis Inês

Authors
  1. Luisa Brites
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefanie Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Andreoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luis Inês
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LB study design, data collection and analysis, preparation of the manuscript, manuscript revision and final approval. SS data collection, manuscript revision and final approval. LA data analysis, manuscript revision and final approval. LI study design, data analysis, manuscript revision and final approval.

Corresponding author

Correspondence to Luis Inês.

Ethics declarations

Conflicts of interest

There were no conflicts of interest. All included patients signed an informed consent form prior to any study procedures.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 22 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brites, L., Silva, S., Andreoli, L. et al. Effectiveness of reproductive health counseling of women with systemic lupus erythematosus: observational cross-sectional study at an academic lupus clinic. Rheumatol Int 41, 403–408 (2021). https://doi.org/10.1007/s00296-020-04671-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-020-04671-9

Keywords

Search

Navigation