Optimizing Pregnancy and Reproductive Health Outcomes Among Individuals with Rheumatic Diseases

September 27, 2022

Mehret Birru Talabi, MD PhD, assistant professor of Medicine in the Division of Rheumatology and Clinical Immunology at the University of Pittsburgh, has conducted a series of research studies that assess pregnancy outcomes across individuals with rheumatic diseases (RMDs).

Her research specifically focuses on clinician and patient-related factors that contribute to pregnancy outcomes, as well as approaches to enhancing reproductive health care in rheumatology.

Clinician Factors

In her recent research studies, Dr. Talabi has found that gaps in family planning care exist for people with RMDs. Specifically, gaps in contraception care may lead to medically ill-timed and undesired pregnancies, which may contribute to the adverse pregnancy outcomes seen across those with RMDs.

In a national qualitative study, rheumatologists were surveyed through phone-based and in-person interviews about family planning care in rheumatology.

Common themes that resulted from this analysis were that rheumatologists do feel responsible for providing family planning care, but recognize that there are barriers to providing family planning care. Reasons such as competing priorities, a lack of time, and a lack of up-to-date knowledge about contraception types, safety, and efficacy are why rheumatologists may not prescribe contraception to patients with RMDs.1 Most of the participating rheumatologists did indicate they would value patient care collaboration with an OB-GYN, but rarely did so in clinical practice.

Patient Factors

Two other recent research studies2,3 from Dr. Talabi examined what women with RMDs know about their reproductive health in the context of their diseases and what factors influence patients to use or not use contraception.

Results showed that people felt that hormonal contraception was unsafe in the context of their diseases, even people without clear disease-related health risks related to contraception. Patients were particularly concerned about the safety of exogenous hormones, while others were advised by clinicians not to use any form of hormonal contraception.

However, some patients were open to using contraception, especially if they felt they were too ill to parent a child. Other patients felt fatigued by the number of medications they were prescribed, which undermined interest in contraception.

Solutions

There are a variety of solutions for decreasing adverse pregnancy outcomes in women with RMDs.

One of the main solutions is to develop education and training for clinicians around pregnancy management, contraception, and medicine safety through certification, CME offerings, and enhanced fellowship training.

Other solutions involve developing communication tools such as scripts, reminders, and other prompts to encourage clinicians to provide care. Partnering with OB-GYNs is another crucial method for creating rapid pathways for care, as well as providing patient-directed educational resources through digital family planning channels that help empower patients to have autonomy over their health.

Ultimately, the research indicates that a patient-centered framework for reproductive health care in rheumatology that focuses on patient education, clinician training, collaborative care with OB-GYNs, and a holistic overview of a woman’s family planning preferences will best meet patients’ reproductive health care needs.

References

  1. Birru Talabi et al., AC&R 2019; Daniels & AbnaNCHS 2020
  2. Birru Talabi et al., BMC Rheum 2019
  3. Birru Talabi et al., Contraception 2021