Apr. 08, 2011

Contraceptive Counseling and Use Among Women With Lupus

Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality?
Yazdany J, Trupin L, Kaiser R, Schmajuk G, Gillis JZ, Chakravarty E, and Schwarz EB. (2011).  Arthritis Care & Research (Hoboken) 63: 358-365.

What is the topic?
Lupus is most common in women of reproductive age and, therefore, issues surrounding pregnancy and contraception are of importance to most lupus patients. Although there is a lot of conflicting information about the relationship of hormones to lupus, some studies support the notion that changes in certain hormone levels can affect the risk of flares in women with lupus. Since it is best to plan pregnancy when lupus is adequately controlled, it is important that women with lupus have access to adequate methods of contraception. This study examined the value of contraceptive counseling for women with lupus. 

What did the researchers hope to learn?
The researchers hoped to learn whether contraceptive counseling had effects on the frequency of use of contraceptives. 

Who was studied?
715 women with lupus participated in the University of California Lupus Outcomes Study. Only English-speaking, sexually active women aged 19-44 years who would be able to become pregnant were included in the study. The women were recruited to the study from doctors’ offices, patient support groups, from conferences, and through the media. 

How was the study conducted?
The study was done with a yearly telephone interview during which patients were asked about their symptoms, medications, history of anti-phospholipid syndrome (APS) and/or blood clots, how they were doing physically and mentally, disability, education, employment, and use of the health care system. Other information that was collected included the participants’ age, race/ethnicity, marital status, and reproductive history (including number of pregnancies and pregnancy outcomes).    

Based on this questionnaire, some women were identified as being at risk for an unplanned pregnancy. These patients were asked to report on the frequency of contraceptive use, type of contraceptive used during the past three months, and whether or not they had received contraceptive counseling by a health care provider.  

What did the researchers find?
Of the women who participated in the study, most were Caucasian and married or living with a partner. Half of them had obtained a college degree and only a minority had not completed high school. 

Most of the women were pregnant at some time in the past or presently. Of the 409 pregnancies evaluated, 265 resulted in live births, 57 were ended by planned abortions, 61 resulted in early miscarriages, 6 resulted in late miscarriages, and 7 were ectopic pregnancies (the baby cannot thrive because it is implanted in a tube instead of the uterus).

86 women (45%) were at risk for unplanned pregnancy. Most of these women reported that they were trying to avoid becoming pregnant and that they were always using contraception during the past three months. However, most of these women were only using “barrier” contraceptive methods that are known to have higher 1-year failure rates than hormone contraceptives or intrauterine devices (IUDs). In addition, most of these women had not received contraceptive counseling from a health care provider in the last year. 

Caucasian women were more likely to use the most effective methods of contraception compared to those in other racial/ethnic groups. Also, those who visited a gynecologist/obstetrician at least once in the last year were more likely to use effective contraception and were also more likely to have received contraceptive counseling. 

Of the women at risk for unplanned pregnancy who also had a history of blood clots or APS, most were using barrier contraceptive methods and a few of them were using hormonal contraceptives, which are not proven to be safe for people at risk for blot clots.       

What were the limitations of the study?
One possible limitation of this study is that it was conducted by telephone interview. Underreporting of unintended pregnancies and induced abortions has been found in previous research. Also, the history of APS was not available for all women included in the study. 

What do the results mean for you?
This study does not tell any individual person what is the best form of contraceptive for them personally. It does suggest the possibility that contraceptive counseling might be a helpful way for lupus patients to best plan the timing of their pregnancies in order to optimize the success of having a healthy baby.

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