SAT0181 CONTRACEPTIVE COUNSELING AND USE AMONG WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS AT RISK FOR UNPLANNED PREGNANCY
Authors: Francisca Aguiar, Rui Costa, Iva Brito
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Systemic Lupus Erythematosus (SLE) is an autoimmune disease that primarily affects women of reproductive age. Disease activity and medication use can complicate pregnancies in SLE, due to the disease itself and/or exposure to teratogenic medications. Therefore, these patients should be counseled and are candidates for highly effective contraceptive methods. <h3>Objectives</h3> To examine contraceptive counseling and use among SLE patients attending our Rheumatology Department. <h3>Methods</h3> Cross-sectional study in which women aged 15-50 followed in our Rheumatology Centre with SLE diagnosis completed a researcher-administered survey. Premenopausal women who were sexually active 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). The statistical analysis was performed using SPSS 23.0, and <i>p</i>&lt;<i>0.05</i> was taken to indicate statistical significance. <h3>Results</h3> 95 women were interviewed, of these, 60 were considered to be at risk for unplanned pregnancy. Their median age was 36 years (range 17-48), and median disease duration 9.9 years (range 0.25-37.0). 85% were aware of the complications associated with pregnancy in their medical condition and 73.3% had received contraceptive counseling. Fifty-six patients (93.3%) reported consistent contraceptive use. Younger patients were more likely to have received contraceptive counseling (35.0 [17-46] years versus 42.5 [20-48] years, p=0.021). Counseling was more frequently reported by patients with higher educational level (p=0.026). Those who were counseled were using more effective contraceptives and in logistic regression contraceptive counseling was a predictor of highly effective contraception use (OR=13.1, p&lt;0.0001). Women using teratogenic medications or with a history of thrombosis were no more likely to have received contraceptive counseling or to use more effective contraceptives. Those with positive aPL were using more effective contraceptives (p=0.024). In our model, having a high school degree and positive lupus anticoagulant predicted contraceptive counseling (OR=12.6, p=0.041; OR=3.1, p=0.02, respectively). <h3>Conclusion</h3> This study highlights the importance of contraceptive counseling in SLE patients at risk for unplanned pregnancy. A multidisciplinary team including rheumatologists, gynecologists and family phsycians is needed to improve the education and provision of adequate contraceptive counseling to these women. <h3>References</h3> [1] Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: a meta-analysis of studies published between years 2001-2016. J Autoimmun. 2017;79:17-27. [2] Yazdany J, et al. Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality?.Arthritis Care Res (Hoboken). 2011;63:358-65. <h3>Disclosure of Interests</h3> None declared