Rosalind Ramsey-Goldman, MD: The Impact of the US Abortion Policy on Rheumatology Clinical Practice

Rosalind Ramsey-Goldman, MD

Credit: Lupus Foundation of America

In an interview with HCPLive Rheumatology, Rosalind Ramsey-Goldman, MD, associated with the epidemiology of systemic lupus erythematosus, pregnancy and rheumatic diseases, osteoporosis, steroid-induced osteoporosis, at Northwestern Medicine, discusses her study, “The impact of US abortion policy on rheumatology clinical practice: a cross-sectional survey of rheumatologists.”

What inspired your team to conduct research on the impact of US abortion policy on rheumatology clinical practice?

We wanted to assess the impact of the Dobbs v Jackson Women’s Health overturning Roe v Wade in the first 6 months after the ruling. The majority of the patient’s rheumatologists treat are women, many in their childbearing years requiring expert care in managing medications that not only treat the disease, but prevent damage to vital organs, but also to assist women who want to have a pregnancy in the setting of managing their chronic condition as safely as possible. To that end, we obtained Institutional Review Board permission from the University of Pittsburgh to conduct a confidential web-based survey to sample US-based rheumatologists to assess the impact of this ruling on the care of their rheumatic disease patients and on their perceived risk to criminalization.

What were the key findings or insights from your research?

Rheumatologists in states with restrictions on abortion are changing practice and using less effective treatments for rheumatic diseases. When we have more effective treatments for our diseases and not being able to use them is not doing the best for our patients. We have the training to manage these diseases but laws and access to care have the potential result in harm especially to marginalized populations.

For example, rheumatologists changed or planned to change how often they prescribed methotrexate (a key medication used to treat rheumatoid arthritis), in abortion-restricted states versus abortion-protected states, 13.0% vs 5.3%, respectively. The same trend for changing prescription strategy was also present for a standard of care treatment for lupus nephritis, mycophenolate, 8.7% vs 1.3%.

Can you tell me a bit more about the concerns that were raised by these results?

From the patient perspective, here are concerns about access to medication and abortion care.

Patients encountered challenges to filling their methotrexate prescriptions in abortion-restricted states versus abortion-protected states, 23.2 % versus 11.8% respectively.

Rheumatologists who practice in abortion-restricted states are less comfortable referring a patient for abortion without fear of reprisal post-Dobbs compared to pre-Dobbs, 34.8% versus 83.1 %, respectively.

Are there any recommendations or key takeaways from your research that you would like to emphasize for fellow rheumatologists and healthcare policymakers?

We need to focus on what we can control and change now. The goal here is to address the education needs of those involved with caring for women with rheumatic diseases. We can work towards providing vital information to our profession and this includes the following: regarding use of teratogenic medications (cause birth defects) but are effective in controlling rheumatic diseases and minimizing disability and increased morbidity and mortality fromrheumatic disease, and the need for effective contraception in those circumstances. We are concerned about using medications to treat rheumatic diseases which are not effective as newer medications. There are significant side effects from the older treatments, such as use of corticosteroids which have many side effects. The newer medications give us the opportunity to use less corticosteroids as treatment for rheumatic diseases, Furthermore, when counseling a family about a future pregnancy, it is important to know when and what to recommend in adjusting medications if pregnancy is desired to improve the outcomes for both mother and baby.

Does your team plan on doing any future research on this topic?

Yes, our team is applying for grant funding to expand this study and to learn about the current state of reproductive health planning now that more than 18 months have passed since the Dobbs vs Jackson Women’s Health overturned Roe vs Wade. We are working on multiple fronts to educate healthcare providers about counseling on the teratogenic potential of medications used in the treatment of rheumatic diseases, and consequently the types of contraception (highly effective to less effective) to prevent pregnancy when the woman has active disease which can worsen her disease course, and also the potential exposure to a medication that can harm the developing fetus.

Is there anything else you’d like our audience to know?

While abortion restrictions provide an urgent stimulus to augment safer prescribing practices, our results raise concern that some patients are losing access to effective evidence-based treatments based on their childbearing potential rather than medical evidence.