POS0736 EVALUATING CONTRACEPTIVE COUNSELING PRACTICES IN LUPUS PATIENTS OF A RACIALLY DIVERSE POPULATION
Authors: H. Weisleder, C. Osuorji, Y. Jin, M. Fazzari, B. Ayesha
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Systemic Lupus Erythematosus (SLE) is an autoimmune disease that primarily affects women of reproductive age and confers increased risk of adverse maternal-fetal outcomes. Further, many medications used to manage SLE can lead to fetal malformations. Pre-pregnancy planning and contraceptive counseling have been shown to improve pregnancy outcomes and are a vital part of rheumatological outpatient care. <h3>Objectives:</h3> We investigated the rates of contraceptive counseling in a racially diverse population of female SLE patients and aimed to discover any disparities in care. <h3>Methods:</h3> After Institutional Board Review (IRB) approval, we queried electronic medical records (EMR) to identify all female SLE patients of reproductive age (15-50 years) following at the Family Care Center (FCC) for Lupus at Montefiore Medical Center. Patient records were searched to assess contraceptive counseling documentation by providers from September 2021 to October 2023. The EMR was reviewed for demographic data, the presence/absence of contraceptive counseling, contraception methods, baseline laboratory data, and details regarding disease presentation. Rates of contraceptive counseling were compared among women of different ages and races. Study groups were further stratified by age and results were compared between reference maternal age (under or equal to 35 years) versus advanced maternal age (great than 35 years). Statistical analysis was performed using Wilcoxon rank sum test, Pearson's Chi-squared test and Fisher's exact test. Two-sided p-values ≤ 0.05 were considered statistically significant. <h3>Results:</h3> A total of 98 patients were included in this study, among them, 48 (49%) were Hispanic, 41 (42%) were Non-Hispanic Black (NHB), and 9 (9%) were Other. Thirty-nine patients (39.8%) were offered contraceptive counseling. Of those, the average age was 33.9 years, while for those who were not offered counseling the average age was 37.2 years (p= 0.043). Women under or equal to 35 years old were more likely to receive contraceptive counseling than those of advanced maternal age (p= 0.007). Counseling was offered in 25 (64%) Hispanic patients, 13 (33%) NHB, and 1 (2.6%) Other (p = 0.03). There was no association between contraceptive counseling and primary language (p = 0.054). <h3>Conclusion:</h3> Our results highlight two important care gaps. Women above the age of 35 were significantly less likely to get contraceptive counseling compared to women 15-35 years old. Further, NHB women were also less likely to receive counseling than Hispanic women. Given the significant morbidity and mortality associated with pregnancy related complications in SLE patients, and the increasing rates of pregnancies in women aged 35 and older, it is vital for rheumatologists to ensure that all their patients are counseled on the importance of contraception to reduce this health disparity. Given these results, we introduced an ongoing quality improvement project at our clinic to improve provider documentation of contraceptive counseling. <h3>REFERENCES:</h3> [1] Yazdany J, Trupin L, Kaiser R, Schmajuk G, Gillis JZ, Chakravarty E, Schwarz EB. Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality? Arthritis Care Res (Hoboken). 2011 Mar;63(3):358-65. doi: 10.1002/acr.20402. Epub 2010 Nov 15. PMID: 21080446; PMCID: PMC3115517. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>