Rheumatic Disease Does Not Preclude Pregnancy

Dr. Chakravarty

Unfortunately, many patients with rheumatic disease at risk of pregnancy do not use any birth control. Those that do often use less effective methods, such as condoms.⁶ Even patients using teratogenic drugs often do not have adequate birth control, and they may not be any more likely to use contraception than women not on such drugs.⁷

Why would patients not use adequate contraception? Lack of patient education and dialogue with physicians may play a role. Patients may misperceive their level of fertility or have concerns about the effects of contraception on their disease. They may be reluctant to add medications to an already complicated regimen. Patients may misunderstand or forget information, or they may simply forget to take their birth control regularly. They may be anxious about discussing the topic with their healthcare provider, and they may not know which provider they should ask.^3,8 Other patients may choose not to practice medical contraception due to their religious beliefs.

Healthcare providers may not be providing the time and depth to address these topics. In a survey of women with lupus, rheumatoid arthritis and inflammatory bowel disease in the U.S., 30% of patients felt that their healthcare providers had not adequately addressed their family planning concerns.⁹ Concerningly, one study of women with lupus found that women with the highest disease activity were the least likely to receive family planning counseling.¹⁰

Dr. Birru Talabi

Mehret Birru Talabi, MD, PhD, is an assistant professor of rheumatology and clinical immunology at the University of Pittsburgh. She notes, “Some rheumatologists may assume that other providers are managing contraception and family planning for patients, and I think it’s a faulty assumption. I think there are some primary care doctors who are not as familiar with the care of women with rheumatic diseases, and some who probably believe that rheumatologists should manage most aspects of patient care, including family planning care and counseling.”

In contrast, many rheumatologists believe the primary care physician should address these concerns. Rheumatologists may be ambivalent about whether discussing these issues is part of their responsibilities or is an optimal use of time.¹¹

Eliza Chakravarty, MD, is a rheumatologist in Oklahoma City, and an associate member of the Oklahoma Medical Research Foundation. She notes, “Women with these conditions are going to see their rheumatologists more than they see any other doctor. As rheumatologists, we spend so much of our time adjusting their medicines, worrying about their disease activity, looking for toxicities of their medicines, but we may forget about the importance of contraception in women who take these teratogenic medications for years.” She also finds that many community obstetrician/gynecologists are worried they are going to cause harm, so they are sometimes reluctant to provide contraceptive medications that may otherwise be reasonable.