Education Level, Medication Knowledge, and Contraceptive Practices in Women with Rheumatic Diseases: Discrepancies Between Knowledge and Practice

Objective: To evaluate contraceptive practices and patients’ knowledge regarding the effects of antirheumatic medications on pregnancy in women with rheumatic diseases.Methods: This cross-sectional, questionnaire-based study included women of reproductive age with rheumatic diseases. Data were collected using a structured questionnaire assessing demographics, clinical characteristics, contraceptive use, recent unprotected intercourse, physician counseling, and awareness of potential risks of medications during pregnancy. Medications were classified according to the 2020 American College of Rheumatology guideline, and contraceptive methods were categorized by effectiveness using the TIER system; tier 1 and tier 2 methods were considered effective. The primary outcome was the proportion of patients using effective contraception.Results: A total of 150 women (39 [34-44] years of age) were included. Among 128 (85.3%) contraceptive users, 45 (35.2%) used effective methods, while 83 (64.8%) used less effective methods. Ninety-eight (65.3%) patients were receiving medications requiring avoidance during pregnancy. Contraceptive use, knowledge of medication effects, and recent unprotected intercourse were similar between receiving and not receiving medications requiring avoidance during pregnancy (P > .05). Knowledge about medication safety and counseling by rheumatologists increased with educational level (P = .004 and P = .029, respectively), whereas the use of effective contraceptive methods did not (P = .238).Conclusion: Despite greater knowledge about medication safety and increased counseling by rheumatologists at higher educational levels, the use of effective contraception remained unchanged, suggesting that factors beyond knowledge and counseling influence contraceptive behavior.