Rheumatologist as Family Planning Counselor

Reproductive-age female patients face potential pregnancy complications, but rheumatologists rarely discuss family planning. New research reveals barriers preventing rheumatologists from starting these conversations.

Both the American College of Rheumatology and the European League Against Rheumatism support family-planning counseling and reproductive health care (FPCC) for all reproductive-age females with rheumatic diseases. However, a new study, published in Arthritis Care & Rheumatology, identified six factors responsible for the minimal FPCC communication between rheumatologists and patients.

This is the first study exploring rheumatologists’ perspectives about FPCC, and no guidelines exist on what topics they should address.

“Rheumatologists feel a sense of responsibility to provide some aspects of FPCC to reproductive-age female patients,” the investigators said. “However, their own apprehensions about managing complicated pregnancies may negatively influence how they advise patients about pregnancy planning or avoidance.”

Providers acknowledged attitudes toward FPCC could influence their advice, researchers said. But, open conversations could help providers anticipate pregnancies, mitigate health risks, and facilitate healthy pregnancies.

To pinpoint rheumatologists’ perspectives, attitudes, and practices around FPCC, researchers interviewed 12 providers. Six themes on how rheumatologists approach this topic emerged:

1. Rheumatologists feel responsible for providing FPCC.
2. They experience tension between respecting patient autonomy and their own anxieties about managing high-risk pregnancies.
3. FPCC guidelines don’t exist, and competing clinical priorities often take precedence.
4. They are reluctant to prescribe contraception.
5. They want greater access to resources than can inform FPCC.
6. They recognize the benefits of multidisciplinary collaboration with gynecologists, though most didn’t refer patients.

Based on results, investigators said, rheumatologists could benefit from clarifications about their FPCC roles and responsibilities. They recommended, as a starting point, that rheumatologists address their anxieties and initiate FPCC conversations with all reproductive-age female patients to determine their reproductive goals and needs. Additional changes could include identifying patients’ contraception requirements and making gynecology referrals.

Ultimately, investigators said, rheumatologists should remember conversations around pregnancy don’t have to be cause for concern.

“An important message to providers and patients is that many women with rheumatic disease have successful pregnancies and healthy babies,” they said.

REFERENCE

Talabi M, Clowse M, Blalock S, Hamm M, Borrero S, Perspectives of Adult Rheumatologists Regarding Family Planning Counseling and Care: A Qualitative Study. Arthritis Care & Research (2019), doi: 10.1002/acr.23872