May. 16, 2012

Reproductive Behavior Among Women with Lupus

Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus
Clowse ME, Chakravarty E, Costenbader KH, Chambers C, and Michaud K. (2012). Arthritis Care & Research (Hoboken) 64: 668-674.

What is the topic?

Lupus affects mostly women in their childbearing years. Previous studies suggest that women with chronic illnesses, including those with cancer, for example, may have fewer children than planned, which is expected to have a significant impact on their quality of life.

What did the researchers hope to learn?

The researchers hoped to learn about pregnancy-related outcomes in women with lupus and rheumatoid arthritis (RA).

Who was studied?

Women with systemic lupus erythematosus (n=114) and RA (n =578) were included in the study.

How was the study conducted?

In the fall of 2009, a questionnaire about reproductive health was mailed to female participants in the National Data Bank for Rheumatic Diseases. All survey responses were received within a three-month time period. Demographic information about the survey respondents (including age, age at disease onset, race, education, and marital status) was collected by the Data Bank prior to mailing of the reproductive health survey.

The questionnaire included inquiries about reproductive history, including the total number of pregnancies, live births, miscarriages, and pregnancy terminations. Women were also asked questions to help determine reproductive intent, whether they were clinically infertile, and if they were using any form of reproductive assistance (such as oral or injectable medication, in vitro fertilization, or other methods).

For each disease group (lupus and RA), women were divided into the following groups: women who had fewer children than intended (“Group A”), women who had the same number of children as they intended (“Group B”), and women who had completed childbearing at the time of diagnosis (“Group C”).

What did the researchers find?

The survey respondents were women aged 54-59, mostly Caucasian (although Hispanics and African-Americans were also included), older than 35 years of age, and had lupus or RA for an average of about 19 years. The women with either lupus or RA had similar disease duration, severity, functional ability, and overall quality of life. In addition, most of the women were in their mid-to-late thirties when they experienced their first disease symptom, but significantly more women with lupus than RA experienced their first symptom prior to their 35th birthday.

The proportions of women distributed among Groups A, B, and C were similar for those with lupus as compared to those with RA. The average number of pregnancies, children, and terminations was similar among women in the two disease groups. However, women with lupus were less likely to report infertility than those with RA, but had a higher rate of miscarriages.

The number of pregnancies, rate of infertility, and number of elective terminations was similar in Groups A, B, and C of women with lupus. However, women with lupus in Group A had, on average, one fewer child than did women in Groups B or C.

Overall, women with lupus who reported disease-related child welfare concerns had fewer conceptions than did women who did not indicate these concerns. In addition, overall, among women with lupus, infertility, age at lupus onset, and miscarriage did not significantly impact the number of pregnancies or live births.

What were the limitations of the study?

The women who filled out the survey may have more education and/or more difficult reproductive histories, and were more likely to be Caucasian. It could also be that the women who filled out the long survey, which included questions about sensitive issues, were more comfortable addressing those issues than those who did not fill out the survey.

What do the results mean for you?

In both groups of women (those with RA and those with lupus), concerns about inability to care for a child, damage from medications, and genetic transmission of disease were all associated with fewer pregnancies. Improved disease management could help address patient concerns about the potential negative effects of disease-related disability on childrearing. Patient concerns about the effects of medication on offspring and the potential for genetic transfer of disease, however, could be addressed through improved education of both physicians and patients. If deemed medically safe by treating physicians, there may be safe drug options that women can take during pregnancy that can both control disease activity and prevent negative outcomes for a developing fetus.

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