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The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus.

Publication ,  Journal Article
Sims, CA; Eudy, AM; Doss, J; Rogers, JL; Sadun, RE; Criscione-Schreiber, L; Sun, K; Clowse, ME
Published in: Lupus
December 2023

Women with systemic lupus erythematosus (SLE) who get pregnant while SLE is active or while on teratogens have higher risk of poor pregnancy outcomes. The American College of Rheumatology (ACR) Reproductive Health Guidelines recommend women conceive when SLE is well controlled and treated with pregnancy-compatible medications. The Healthy Outcomes in Pregnancy with SLE Through Education of Providers (HOP-STEP) Intervention was created to ascertain pregnancy interest and contraceptive use followed by a personalized pregnancy prevention and/or planning discussion (https://www.LupusPregnancy.org). All study participants were adult females enrolled in a prospective registry who met ACR or SLICC criteria. Women were defined as "not medically ready for pregnancy" if they were currently prescribed a teratogen, had proteinuria ≥500 mg, or had elevated SLE activity according to the physician's global assessment. Two time periods were assessed: 2/2018-12/2019 and 10/2020-4/2021 to evaluate pre- and post-pandemic periods, with some post-pandemic visits taking place via telehealth. The interest in pregnancy was similar between the first time period (17%) and the second time period, whether in-person (18%) or virtual (18%). Pregnancy interest was assessed significantly more frequently during in-person visits (90%) compared to virtual encounters (67%) (p = .02). Contraceptive use was not significantly different during either time period with use of a teratogen or increased SLE activity. Of the 52 women in both time periods who were not medically ready for pregnancy and were not on effective contraception, three women (5.8%) conceived. None of the women who were using moderate or highly effective contraception became pregnant. Pregnancy outcomes were similar between unintended or high-risk and well-timed pregnancies. The HOP-STEP Intervention effectively identified pregnancy interest, giving rheumatologists the opportunity to address patient reproductive goals, optimize disease activity, and adjust medication regimens prior to conception.

Duke Scholars

Published In

Lupus

DOI

EISSN

1477-0962

Publication Date

December 2023

Volume

32

Issue

14

Start / End Page

1666 / 1674

Location

England

Related Subject Headings

  • Teratogens
  • Pregnancy Outcome
  • Pregnancy
  • Lupus Erythematosus, Systemic
  • Humans
  • Female
  • Contraceptive Agents
  • Contraception
  • Arthritis & Rheumatology
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Sims, C. A., Eudy, A. M., Doss, J., Rogers, J. L., Sadun, R. E., Criscione-Schreiber, L., … Clowse, M. E. (2023). The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus. Lupus, 32(14), 1666–1674. https://doi.org/10.1177/09612033231216602
Sims, Catherine A., Amanda M. Eudy, Jayanth Doss, Jennifer L. Rogers, Rebecca E. Sadun, Lisa Criscione-Schreiber, Kai Sun, and Megan Eb Clowse. “The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus.Lupus 32, no. 14 (December 2023): 1666–74. https://doi.org/10.1177/09612033231216602.
Sims CA, Eudy AM, Doss J, Rogers JL, Sadun RE, Criscione-Schreiber L, et al. The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus. Lupus. 2023 Dec;32(14):1666–74.
Sims, Catherine A., et al. “The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus.Lupus, vol. 32, no. 14, Dec. 2023, pp. 1666–74. Pubmed, doi:10.1177/09612033231216602.
Sims CA, Eudy AM, Doss J, Rogers JL, Sadun RE, Criscione-Schreiber L, Sun K, Clowse ME. The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus. Lupus. 2023 Dec;32(14):1666–1674.
Journal cover image

Published In

Lupus

DOI

EISSN

1477-0962

Publication Date

December 2023

Volume

32

Issue

14

Start / End Page

1666 / 1674

Location

England

Related Subject Headings

  • Teratogens
  • Pregnancy Outcome
  • Pregnancy
  • Lupus Erythematosus, Systemic
  • Humans
  • Female
  • Contraceptive Agents
  • Contraception
  • Arthritis & Rheumatology
  • Adult