Contraceptive counseling and use among women with systemic lupus erythematosus: A gap in health care quality?

Jinoos Yazdany, Laura Trupin, Rachel Kaiser, Gabriela Schmajuk, Joann Zell Gillis, Eliza Chakravarty, Eleanor Schwarz

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Objective. Disease activity and medication use can complicate pregnancies in patients with systemic lupus erythematosus (SLE). We therefore examined contraceptive counseling and use among women in the University of California, San Francisco Lupus Outcomes Study. Methods. In 2008, we queried participants regarding their pregnancy intentions, contraceptive use, and receipt of contraceptive counseling. Premenopausal women age <45 years who were sexually active with men were considered at risk of pregnancy. We compared self-reported rates of contraceptive counseling and use stratified by treatment with teratogenic medications and by history of thrombosis or antiphospholipid antibodies (aPL), using chi-square tests. We used logistic regression models to examine predictors of contraceptive counseling and use. Results. Among 206 women, 86 were at risk for unplanned pregnancy. Most (59%) had not received contraceptive counseling in the last year, 22% reported inconsistent contraceptive use, and 53% depended solely on barrier methods. Intrauterine device contraceptives (IUDs) were used by 13%. Women using potentially teratogenic medications were no more likely to have received contraceptive counseling, to have used contraception consistently, or to have used more effective contraceptives. A history of thrombosis or aPL did not account for low rates of hormonal methods. Four women with a history of thrombosis or aPL were using estrogen-containing contraceptives. Conclusion. Most women at risk for unplanned pregnancy reported no contraceptive counseling in the past year, despite common use of potentially teratogenic medications. Many relied upon contraceptive methods with high failure rates; few used IUDs. Some were inappropriately using estrogen-containing contraceptives. These findings suggest the need to improve the provision of contraceptive services to women with SLE.

Original languageEnglish (US)
Pages (from-to)358-365
Number of pages8
JournalArthritis Care and Research
Volume63
Issue number3
DOIs
StatePublished - Mar 1 2011
Externally publishedYes

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Quality of Health Care
Contraceptive Agents
Systemic Lupus Erythematosus
Counseling
Antiphospholipid Antibodies
Unplanned Pregnancy
Intrauterine Devices
Thrombosis
Contraception
Pregnancy
Estrogens
Logistic Models
San Francisco
Chi-Square Distribution

ASJC Scopus subject areas

  • Rheumatology

Cite this

Contraceptive counseling and use among women with systemic lupus erythematosus : A gap in health care quality? / Yazdany, Jinoos; Trupin, Laura; Kaiser, Rachel; Schmajuk, Gabriela; Gillis, Joann Zell; Chakravarty, Eliza; Schwarz, Eleanor.

In: Arthritis Care and Research, Vol. 63, No. 3, 01.03.2011, p. 358-365.

Research output: Contribution to journalArticle

Yazdany, Jinoos ; Trupin, Laura ; Kaiser, Rachel ; Schmajuk, Gabriela ; Gillis, Joann Zell ; Chakravarty, Eliza ; Schwarz, Eleanor. / Contraceptive counseling and use among women with systemic lupus erythematosus : A gap in health care quality?. In: Arthritis Care and Research. 2011 ; Vol. 63, No. 3. pp. 358-365.
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abstract = "Objective. Disease activity and medication use can complicate pregnancies in patients with systemic lupus erythematosus (SLE). We therefore examined contraceptive counseling and use among women in the University of California, San Francisco Lupus Outcomes Study. Methods. In 2008, we queried participants regarding their pregnancy intentions, contraceptive use, and receipt of contraceptive counseling. Premenopausal women age <45 years who were sexually active with men were considered at risk of pregnancy. We compared self-reported rates of contraceptive counseling and use stratified by treatment with teratogenic medications and by history of thrombosis or antiphospholipid antibodies (aPL), using chi-square tests. We used logistic regression models to examine predictors of contraceptive counseling and use. Results. Among 206 women, 86 were at risk for unplanned pregnancy. Most (59{\%}) had not received contraceptive counseling in the last year, 22{\%} reported inconsistent contraceptive use, and 53{\%} depended solely on barrier methods. Intrauterine device contraceptives (IUDs) were used by 13{\%}. Women using potentially teratogenic medications were no more likely to have received contraceptive counseling, to have used contraception consistently, or to have used more effective contraceptives. A history of thrombosis or aPL did not account for low rates of hormonal methods. Four women with a history of thrombosis or aPL were using estrogen-containing contraceptives. Conclusion. Most women at risk for unplanned pregnancy reported no contraceptive counseling in the past year, despite common use of potentially teratogenic medications. Many relied upon contraceptive methods with high failure rates; few used IUDs. Some were inappropriately using estrogen-containing contraceptives. These findings suggest the need to improve the provision of contraceptive services to women with SLE.",
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AB - Objective. Disease activity and medication use can complicate pregnancies in patients with systemic lupus erythematosus (SLE). We therefore examined contraceptive counseling and use among women in the University of California, San Francisco Lupus Outcomes Study. Methods. In 2008, we queried participants regarding their pregnancy intentions, contraceptive use, and receipt of contraceptive counseling. Premenopausal women age <45 years who were sexually active with men were considered at risk of pregnancy. We compared self-reported rates of contraceptive counseling and use stratified by treatment with teratogenic medications and by history of thrombosis or antiphospholipid antibodies (aPL), using chi-square tests. We used logistic regression models to examine predictors of contraceptive counseling and use. Results. Among 206 women, 86 were at risk for unplanned pregnancy. Most (59%) had not received contraceptive counseling in the last year, 22% reported inconsistent contraceptive use, and 53% depended solely on barrier methods. Intrauterine device contraceptives (IUDs) were used by 13%. Women using potentially teratogenic medications were no more likely to have received contraceptive counseling, to have used contraception consistently, or to have used more effective contraceptives. A history of thrombosis or aPL did not account for low rates of hormonal methods. Four women with a history of thrombosis or aPL were using estrogen-containing contraceptives. Conclusion. Most women at risk for unplanned pregnancy reported no contraceptive counseling in the past year, despite common use of potentially teratogenic medications. Many relied upon contraceptive methods with high failure rates; few used IUDs. Some were inappropriately using estrogen-containing contraceptives. These findings suggest the need to improve the provision of contraceptive services to women with SLE.

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