Clinical Scorecard: Utilization Rates of Contraceptive Methods in Patients with Rheumatic Disorders: A Descriptive Analysis

At a Glance

Key Highlights

• Pregnancy in systemic autoimmune diseases carries risks including disease flares, fetal loss, preeclampsia, and thrombotic events.
• Certain immunosuppressive drugs are teratogenic and must be discontinued before conception; others are compatible or preferred during pregnancy.
• Effective contraception is critical to prevent unplanned pregnancies and associated maternal-fetal complications in this population.

Guideline-Based Recommendations

Diagnosis

• Diagnose systemic autoimmune and rheumatic diseases using current international standards.
• Assess disease activity and organ involvement prior to pregnancy planning.

Management

• Use pregnancy-compatible treatments such as azathioprine, hydroxychloroquine, sulfasalazine, tacrolimus, ciclosporin, and cortisone.
• Discontinue teratogenic drugs (methotrexate, leflunomide, cyclophosphamide, mycophenolate mofetil) before conception.
• Prefer certolizumab and etanercept among bDMARDs during pregnancy; discontinue tsDMARDs before conception.
• Plan pregnancies carefully to minimize maternal and fetal risks.

Monitoring & Follow-up

• Monitor for disease flares, especially in lupus and patients with renal involvement.
• Screen for antiphospholipid syndrome and manage thrombotic risk during pregnancy.
• Monitor fetal heart for heart block in presence of anti-SSA antibodies.

Risks

• Unplanned pregnancy increases risk of maternal and fetal complications.
• NSAIDs should be limited to first two trimesters due to risk of premature ductal closure.
• Use of tsDMARDs during pregnancy is not recommended due to insufficient safety data.

Patient & Prescribing Data

Women with systemic autoimmune and rheumatic diseases aged 18-45 years

Contraceptive use varies across diseases; effective contraception is underutilized despite teratogenic risks and contraindications to pregnancy.

Clinical Best Practices

• Implement standardized reproductive health questionnaires to assess contraceptive use and reproductive intentions.
• Provide patient education on pregnancy risks and contraception tailored to disease and treatment status.
• Coordinate multidisciplinary care involving rheumatologists, gynecologists, and primary care for pregnancy planning and contraception.
• Use electronic health records and registries to monitor treatment safety and pregnancy outcomes.

References

• EULAR 2024 Recommendations on Management of Rheumatic Diseases in Pregnancy
• MARIGYN Project Clinical Trial Registration