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A questionnaire-based study on contraceptive practice in patients with rheumatic disease found no significant difference in age-matched healthy controls

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

Abstract

Objective

Birth control is crucial in preventing unplanned pregnancy. The study analyzed contraceptive practice in women and men with rheumatic disease.

Methods

A questionnaire-based study investigated the actual contraceptive practices in patients of reproductive age from three European countries and compared them to age-matched healthy women and men. Associations between patient characteristics and contraception behavior were analyzed by association analysis.

Results

No significant difference in the frequency of contraception use was found in 133 rheumatic patients compared to 122 healthy controls. The main reason for not using contraception was lack of partner or the wish to become pregnant, whereas the current use of contraception was predominantly to limit family size in general or at this stage of life. Both patients and controls preferred barrier methods (48% and 45%, respectively) followed by hormonal contraceptives (31% and 38%, respectively). Characteristics associated with less use of contraception in patients were living single, having no children, and for being religious, whereas gender and education had no influence. Treatment with teratogenic drugs was no major patient concern, and 13 of 30 female patients using methotrexate, mycophenolate mofetil, or leflunomide did not practice birth control.

Conclusion

Patients used contraception less frequently than healthy individuals, and the main reason for use was to limit family size. Contraception should be an integral part of counseling patients of fertile age, since the patient-preferred methods in case of active disease or therapy with teratogenic drugs were unreliable for the prevention of pregnancy.

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References

  1. 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 

  2. Østensen M, von Esebeck M, Villiger PM (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 

  3. Farr SL, Folger SG, Paulen ME, Curtis KM (2010) Safety of contraceptive methods for women with rheumatoid arthritis: a systematic review. Contraception 82:64–71. https://doi.org/10.1016/j.contraception.2010.02.003

    Article  PubMed  Google Scholar 

  4. Ostensen M (2011) Connective tissue diseases: contraception counseling in SLE—an often forgotten duty? Nat Rev Rheumatol 7:315–316. https://doi.org/10.1038/nrrheum.2011.54

    Article  PubMed  Google Scholar 

  5. Ringheim K (1993) Factors that determine prevalence of use of contraceptive methods for men. Stud Fam Plann 24:87–99

    Article  CAS  Google Scholar 

  6. Kavanaugh ML, Jerman J (2018) Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014. Contraception 97:14–21. https://doi.org/10.1016/j.contraception.2017.10.003

    Article  PubMed  Google Scholar 

  7. Sammaritano LR (2017) Contraception in patients with rheumatic disease. Rheum Dis Clin N Am 43:173–188. https://doi.org/10.1016/j.rdc.2016.12.001

    Article  Google Scholar 

  8. 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 

  9. Skomsvoll JF, Ostensen M, Baste V, Irgens LM (2001) Number of births, interpregnancy interval, and subsequent pregnancy rate after a diagnosis of inflammatory rheumatic disease in Norwegian women. J Rheumatol 28:2310–2314

    CAS  PubMed  Google Scholar 

  10. Wallenius M, Skomsvoll JF, Irgens LM et al (2011) Fertility in women with chronic inflammatory arthritides. Rheumatology (Oxford) 50:1162–1167. https://doi.org/10.1093/rheumatology/keq458

    Article  Google Scholar 

  11. Clowse MEB, Chakravarty E, Costenbader KH et al (2012) Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken) 64:668–674. https://doi.org/10.1002/acr.21593

    Article  Google Scholar 

  12. Lakasing L, Khamashta M (2001) Contraceptive practices in women with systemic lupus erythematosus and/or antiphospholipid syndrome: what advice should we be giving? J Fam Plann Reprod Health Care 27:7–12

    Article  CAS  Google Scholar 

  13. Galappatthy P, Jayasinghe JDD, Paththinige SC et al (2017) Pregnancy outcomes and contraceptive use in patients with systemic lupus Erythematosus, rheumatoid arthritis and women without a chronic illness: a comparative study. Int J Rheum Dis 20:746–754. https://doi.org/10.1111/1756-185X.12996

    Article  PubMed  Google Scholar 

  14. Østensen M (2014) Contraception and pregnancy counselling in rheumatoid arthritis. Curr Opin Rheumatol 26:302–307. https://doi.org/10.1097/BOR.0000000000000044

    Article  PubMed  Google Scholar 

  15. Birru Talabi M, Clowse MEB, Blalock SJ et al (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 

  16. Bassol S, Cravioto MC, Durand M et al (2000) Mesigyna once-a-month combined injectable contraceptive: experience in Latin America. Contraception 61:309–316. https://doi.org/10.1016/s0010-7824(00)00109-8

  17. Pisoni CN, Cuadrado MJ, Khamashta MA, Hunt BJ (2006) Treatment of menorrhagia associated with oral anticoagulation: efficacy and safety of the levonorgestrel releasing intrauterine device (Mirena coil). Lupus 15:877–880. https://doi.org/10.1177/0961203306071706

    Article  CAS  PubMed  Google Scholar 

  18. Banas T, Hadyla-Banas I, Pityński K et al (2014) Use of contraception by women treated with leflunomide due to rheumatic arthritis. J Obstet Gynaecol 34:60–64. https://doi.org/10.3109/01443615.2013.817982

    Article  CAS  PubMed  Google Scholar 

  19. Kabagenyi A, Jennings L, Reid A et al (2014) Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda. Reprod Health 11:21. https://doi.org/10.1186/1742-4755-11-21

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zigler RE, Peipert JF, Zhao Q et al (2017) Long-acting reversible contraception use among residents in obstetrics/gynecology training programs. Open Access J Contracept 8:1–7. https://doi.org/10.2147/OAJC.S126771

    Article  PubMed  PubMed Central  Google Scholar 

  21. Afolabi BM, Ezedinachi EN, Arikpo I et al (2015) Knowledge, non-use, use and source of information on contraceptive methods among women in various stages of reproductive age in rural Lagos, Southwest Nigeria. Open Access J Contracept 6:65–75. https://doi.org/10.2147/OAJC.S80683

    Article  PubMed  PubMed Central  Google Scholar 

  22. Freilich K, Holton S, Rowe H et al (2017) Sociodemographic characteristics associated with the use of effective and less effective contraceptive methods: findings from the understanding fertility management in contemporary Australia survey. Eur J Contracept Reprod Health Care 22:212–221. https://doi.org/10.1080/13625187.2017.1304534

    Article  CAS  PubMed  Google Scholar 

  23. Østensen 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 

  24. 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 

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Funding

This work was supported by the First Research Prize for the social impact of Rheumatic Diseases of the Catalan Rheumatic League: "Contraception study in patients with Rheumatic Diseases”.

Author information

Authors and Affiliations

  1. Department of Rheumatology, Vall d’Hebron University Hospital, Barcelona, Spain

    Andrea Pluma & Sara Marsal

  2. Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain

    Andrea Pluma, Antonio Julià & Sara Marsal

  3. Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain

    Andrea Pluma

  4. Department of Rheumatology, Rehabilitation Clinical Hospital, Cluj-Napoca, Romania

    Mihaela C. Micu

  5. Department of Rheumatology, Immunology and Allergology, University Hospital Inselspital, Bern, Switzerland

    Frauke Förger

  6. Department of Rheumatology, Sorlandet Hospital, Kristiansand, Norway

    Monika Østensen

Authors
  1. Andrea Pluma
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  2. Mihaela C. Micu
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  3. Antonio Julià
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  4. Sara Marsal
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  5. Frauke Förger
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  6. Monika Østensen
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Contributions

MØ designed the study and initiated it. All authors whose names appear on the submission made substantial contributions to the acquisition, analysis, or interpretation of data. The first draft of the manuscript was written by MØ and AP. All authors revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Monika Østensen.

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Conflict of interest

Dr. Pluma Sanjurjo reports received the First Research Prize for the social impact of Rheumatic Diseases from Catalan Rheumatic League. Dr. Micu has nothing to disclose. Dr. Julià has nothing to disclose. Dr. Marsal has nothing to disclose. Dr. Förger has nothing to disclose. Dr. Østensen reports during the last 36 months speaker fees from Novartis, Roche, New Bridge, and UCB. She has been consultant for advisory board for Pfizer and for Galapagos pharmaceutical company.

Ethical approval

The Ethics Committee of Rehabilitation Clinical Hospital, Cluj-Napoca, approved the study protocol (Nr. 6422/Date 12.02.2015). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. The ethics committee officer in Bern, Switzerland and in Barcelona, Spain reviewed the project protocol and questionnaire and confirmed that ethical committee approval was not required for this study conducted anonymously and without access to patient identification. Their consent was initially given verbally, but they provided a written confirmation of their decision on our request before submission of the manuscript. The Ethics Committee of Vall d’Hebron University Hospital approved the study (Acta. 345/Date 27.06.2018). The Ethics Committee of University Hospital Inselspital, Bern approved the study (Req-2019-00143/Date 19.02.2019).

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Pluma, A., Micu, M.C., Julià, A. et al. A questionnaire-based study on contraceptive practice in patients with rheumatic disease found no significant difference in age-matched healthy controls. Rheumatol Int 40, 1473–1480 (2020). https://doi.org/10.1007/s00296-020-04598-1

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  • DOI: https://doi.org/10.1007/s00296-020-04598-1

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