Reproductive Health Counseling in Rheumatology: Gaps, Barriers, and Patient Impact

This study aimed to assess the frequency and factors associated with reproductive health counseling. We also aimed to assess barriers to counseling and introduce clinical interventions that could reduce these barriers.

A total of 101 female patients of childbearing potential who were not planning pregnancy completed a survey that included questions to determine whether they had previously received reproductive health counseling by a rheumatologist. This represented 18% of women aged 18 to 50 years seen in the rheumatology clinic. Four categories of clinical interventions were initiated with a goal to reduce barriers and improve effectiveness of counseling. Rheumatology providers were surveyed before and after implementing these interventions.

Seventy percent of all patients and 85% of patients who took teratogenic medications reported having ever received reproductive health counseling by a rheumatologist. Counseling rates were higher in younger women and those who took teratogenic medications. Women who had previously received counseling were less likely to be unsure whether they were safe to become pregnant and more likely to talk to their rheumatologist if they decided to become pregnant in the future. Patient-reported rates of counseling poorly agreed with medical chart documentation of counseling, except in women taking teratogenic medications. Most providers found the clinical interventions made it easier to provide counseling, and the number of referrals to Family Planning clinic increased by 625%.

Reproductive health counseling for rheumatology patients of childbearing potential is essential. Ongoing efforts should focus on promoting consistent, high-quality counseling that translates into meaningful outcomes for patients.