Rheumatic Disease Does Not Preclude Pregnancy

Dr. Sammaritano

Another expert in this area is Lisa Sammaritano, MD. Dr. Sammaritano is associate professor of clinical medicine in the Division of Rheumatology, Hospital for Special Surgery at Weill Cornell Medicine in New York. Dr. Sammaritano believes that time is the major factor preventing rheumatologists getting involved in preconception and contraceptive planning, but that rheumatologists’ general lack of familiarity with the topic is another barrier.

The Rheumatologist’s Role

Clearly, rheumatologists need to play some role in making sure their patients receive contraception and preconception education. This does not necessarily have to entail prescribing contraceptives, though it may in some cases. Dr. Chakravarty opts not to prescribe contraception in her practice. However, she has an extended conversation about it with new patients, and she brings it up as part of her routine care questions at regular visits.

“One reason I don’t prescribe contraception is because women with autoimmune diseases, particularly lupus, have a higher incidence of HPV,” she explains. “My thinking is that women with autoimmune diseases or who are immunosuppressed cannot clear the virus as easily as healthy people. I make them go to a gynecologist because I want to make sure they have a pap smear and all that reproductive healthcare.” She commonly refers to several gynecologists in the community with whom she has worked with in the past. “Just like I make sure to refer my patients on hydroxychloroquine to an eye doctor for their retinal screening, I make sure they are set up with a gynecologist.”

Dr. Birru Talabi does provide basic contraception to her patients when needed, although there are certain procedures, like IUD insertions, that she refers to an obstetrician/gynecologist. “The point is, we have to be aware that other providers are not necessarily providing contraceptive services. If we are not comfortable managing that contraception piece, then I think it’s important to develop partnerships with women’s health providers in the community, on whom we can rely and have back-and-forth conversations about patients, to ultimately make sure that patients are getting appropriate contraceptive care.”

There is a need for more consistency of care in this area. In a survey of women with lupus, rheumatoid arthritis or inflammatory bowel disease, 40% of U.S. patients reported that they received inconsistent information from different healthcare professionals.⁹

Dr. Sammaritano recommends, “Until we are all better educated in this area, and/or guidelines are available that will be read by a wide range of specialists, the best way to ensure good care is physician contact. Call or email the OB-GYN with your thoughts and questions.”

Educate & Listen to Patients

In providing better contraceptive coverage, patient education is key. Patients should understand that in most cases pregnancy will be an option for them should they desire it. However, patients must also understand that to have the lowest possible risks for mother and baby, they should work closely with their rheumatologist to plan their pregnancy. Patients must understand that well-controlled disease leads to lower risk. They also need to know that although some medications are not safe to take during pregnancy, others remain essential.