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Background: Rheumatic and musculoskeletal diseases (RMDs) frequently affect individuals of childbearing age. During pregnancy, disease control is vital, as disease activity leads to adverse outcomes for both the mother and the baby. Clinical guidance documents on the use of anti-rheumatics in pregnancy by the European Alliance of Associations in Rheumatology (EULAR), the British Society for Rheumatology (BSR), and the American College of Rheumatology (ACR), rely on systematic reviews of available data, but the recommendations are more liberal than the regulators reference safety information (RSI), creating inconsistent information. This misalignment challenges the shared decision-making process between healthcare providers (HCPs) and individuals with RMDs, potentially affecting their therapeutic choices during pregnancy. We hypothesize that such misalignment adversely affects the shared decision-making process and relationship between HCPs and individuals with RMDs. Objectives: The PRAISE survey (Perception of health care providers Regarding Anti-rheumatics in pregnancy and breastfeeding: advice, Information and patient perSpEctives) was designed to explore the perspectives of HCPs on the shared decision-making process regarding the use of anti-rheumatics in pregnancy and breastfeeding, with particular focus on the scenario encompassing conflicting information. Methods: We conducted a multinational, electronic survey among doctors, nurses and midwives in and outside of Europe from May and to December 2023. The survey was promoted by the EULAR Study Group on Reproductive Health & Family Planning (ReHFaP) and was distributed among networks of HCPs working with RMDs and pregnancy. The survey consisted of 24 questions that explored how HCPs feel about prescribing and advising on anti-rheumatic drugs in pregnancy and breastfeeding and their use of clinical guidance documents in clinical practice. It also explored how HCPs perceive different clinical scenarios involving conflicting information between guidance documents and RSI. Results: Responses on all questions were collected from 414 participants from 24 countries (19 EU countries and 5 non-EU countries), 70% of respondents were women (median age of 44 years). The majority were doctors (82%), practicing for >10 years (63.5%), with experience in prescription of anti-rheumatics for pregnant or lactating individuals. The majority of prescribers (88%) felt comfortable when prescribing anti-rheumatics in pregnancy, and 65% responded that they frequently or very frequently collaborate with other medical specialties (Figure 1). The clinical guidance documents were used by 92% of respondents in daily practice, with 83% of respondents reporting them very or extremely useful. Twenty-five percent of the respondents were likely or very likely to discontinue an ongoing treatment if advice between the clinical guidance document and the RSI were conflicting, i.e. if the clinical guidance document supported the continuation of treatment and the RSI stated that the treatment was not compatible with use in pregnancy. On a Visual Analogue Scale from 0-100 (with 100 being "extremely likely"), 60 was the average score reported when questioned about the likelihood that their patient will stop taking a medication if the RSI states that the drug has "a small increased risk of major malformations and should not be used during pregnancy unless your doctor considers the benefits outweigh the risk". Most importantly, 58% reported that conflicting information causes confusion and tension in the patient-doctor relationship (Figure 2). Conclusion: The PRAISE survey highlights the crucial role of clinical guidance documents in instructing HCPs in managing anti-rheumatic drugs during pregnancy in patients with RMDs. However, the noteworthy finding that a quarter of respondents expressed readiness to cease medication use, when confronted with inconsistent advice, underscores the imperative of harmonizing recommendations between scientific societies and regulators. This would safeguard the well-being of mother and child, address patient apprehension and strengthen the patient-doctor relationship. REFERENCES: NIL. Acknowledgements: Kirsten Frohlich (Danish Hospital for Rheumatic Diseases) is kindly acknowledged for her logistic support. Disclosure of Interests: None declared.
Schreiber et al. (Sat,) studied this question.
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