Diagnosis to dialogue: Reproductive health conversations and guideline adherence in women with lupus

ObjectiveTo examine patient-reported adherence to the American College of Rheumatology (ACR) reproductive health guidelines among females of childbearing age with systemic lupus erythematosus (SLE) seen at a tertiary care center.MethodsFemales with SLE aged 18-50 years who were evaluated by a rheumatologist at a tertiary care center from January 2022 to March 2024 were invited to complete an online survey. The survey assessed whether reproductive health topics had been discussed with their rheumatologists, including: contraception, pregnancy planning (i.e., medication compatibility and disease remission), and hydroxychloroquine (HCQ) use during preconception and pregnancy. Descriptive statistics were used to summarize the characteristics of all participants and reproductive health outcomes. Exploratory bivariate analyses identified factors associated with use of effective or highly effective contraception (EHEC), contraceptive counseling, and screening for pregnancy plans among females of reproductive potential.ResultsThe cross-sectional study included 102 participants (mean age 35 years). Most participants identified as White (36.3%) or Asian/Pacific Islander (32.4%). Among participants with pregnancy history after SLE diagnosis (n = 34), most reported having pregnancy planning discussions, including HCQ use, with their rheumatologist. However, fewer than one-third of all participants reported receiving contraceptive counseling by their rheumatologist in the past year. In exploratory analyses, contraceptive counseling varied significantly by race, employment status, disease duration, and who was most likely to initiate reproductive health conversations. EHEC use varied significantly by race, with numerically higher use among White participants (59.4%).ConclusionOur findings highlight specific gaps in reproductive healthcare among females with SLE, alongside areas of high adherence with guidelines. Notable differences in contraceptive use and counseling underscore important opportunities to deliver quality care in this high-risk patient population.