AB0880-HPR FACTORS THAT INFLUENCE PREGNANCY DECISIONS IN WOMEN WITH RHEUMATIC DISEASES
Authors: J. E. Compeán-Villegas, D. Á. Galarza-Delgado, C. M. Skinner Taylor, L. Pérez Barbosa, R. Moyeda Martinez, R. A. Rodriguez Chavez, L. G. Espinosa Banuelos, A. Y. Lujano Negrete
Journal: Annals of the Rheumatic Diseases (2021)

Background: The reproductive capacity of women with rheumatic diseases (RD) could be affected by factors such as sexual dysfunction, reduced gonadal function, foetal losses, drugs, and personal choices [1] . Studies have suggested that women with RD may underestimate their reproductive capacity [2] , which may be reflected in unplanned pregnancies and/or adverse outcomes. One study found that women with rheumatoid arthritis (RA) have longer time to pregnancy compared to those without RA, suggesting that a reduction in fertility may be involved [3] . Another study found that patients with RA have more subfertility related to medication [4] . Aspects of sexual and reproductive health are not routinely addressed, so they are areas of opportunity to improve quality in care and research. Objectives: Identify demographic and clinical factors associated with pregnancy decision in women with RD. Methods: A population study was carried out including women with RD who had their first obstetric event from September 2017 to November 2020. According to the onset of sexual life and the year of conception of the first pregnancy, two groups were formed, who conceived before and after 5 years elapsed. Demographic and clinical data were obtained from medical records. Categorical variables were assessed using χ 2 test and Fisher’s exact test where appropriate. Student’s t-test was used to assess continuous variables. A p value of 0.05 or less was considered significative. Results: Data were collected from 28 women, the main diagnosis was rheumatoid arthritis (21, 75%), followed by systemic lupus erythematosus (7, 25%), 14 of them (50%) were pregnant in the first 5 years after starting sex life. There were no differences in age of onset of sex life (p = 0.362), or other clinical characteristic, but women with pregnancies in the first lustrum had lower percentages of marriage union (35% vs 42%), paid-work (21% vs 28%), and use of highly effective contraception (21% vs 28%). Conclusion: Conclusions: No factors were identified for pregnancies in the first lustrum, but there is a tendency to occur in single women, non-employees, and users of non-highly effective contraceptives methods. Further studies with a larger population are necessary to find modifiable factors and improve outcomes. Table 1. Clinical characteristics. Obstetric event before 5 years Obstetric event after 5 years p-value Total 14 14 Current average age 24.85 +/- 4.3 29.92 +/- 5.7 0.404 Age at the first obstetric event, years 20.92 +/- 2.9 28.00 +/- 5.9 0.05 Age at the onset of rheumatic disease, years 20.71 +/- 5.5 23.42 +/- 4.0 0.135 Average age of onset of sex life, n (%) 18.64 +/- 2.9 18.07 +/- 2.5 0.362 Alcoholism consumption, n (%) 3 (21.42) 4 (28.57) 0.663 Tobacco use, n (%) 3 (21.42) 3 (21.42) Diabetes mellitus, n (%) 0 (0) 1 (7.14) 0.309 Hypertension, n (%) 1 (7.14) 0 (0) 0.309 Depression, n (%) 3 (21.42) 1 (7.14) 0.280 Anxiety, n (%) 2 (14.28) 1 (7.14) 0.541 Pre-pregnancy medication Methotrexate, n (%) 3 (21.42) 5 (35.71) 0.403 Leflunomide, n (%) 1 (7.14) 2 (14.28) 0.541 Sulfasalazine, n (%) 3 (21.42) 2 (14.28) 0.622 Hydroxichloroquine, n (%) 6 (42.85) 4 (28.57) 0.430 Azathioprine, n (%) 1 (7.14) 0 (0) 0.309 Cyclophosphamide, n (%) 2 (14.28) 0 (0) 0.142 Glucocorticoids, n (%) 5 (35.71) 5 (35.71) NA: Not applicable. Image 1. Demographic characteristics. References: [1]Østensen, M., 2017. Sexual and reproductive health in rheumatic disease. Nature Reviews Rheumatology , 13(8), pp.485-493. [2]Birru Talabi, M., Clowse, M., Blalock, S., Switzer, G., Yu, L., Chodoff, A. and Borrero, S., 2019. Development of ReproKnow, a reproductive knowledge assessment for women with rheumatic diseases. BMC Rheumatology , 3(1). [3]Jawaheer, D., Zhu, J., Nohr, E. and Olsen, J., 2011. Time to pregnancy among women with rheumatoid arthritis. Arthritis &amp; Rheumatism , 63(6), pp.1517-1521. [4]Brouwer, J., Fleurbaaij, R., Hazes, J., Dolhain, R. and Laven, J., 2017. Subfertility in Women With Rheumatoid Arthritis and the Outcome of Fertility Assessments. Arthritis Care &amp; Research , 69(8), pp.1142-1149. Disclosure of Interests: None declared