Family planning and pregnancy issues for women with systemic inflammatory diseases: patient and physician perspectives

Abstract

Objectives: To identify family planning and pregnancy (FPP) issues for female patients of childbearing age living with a chronic inflammatory disease and to assess whether current clinical practice routinely provides adequate support to alleviate these concerns.

Setting: Multinational survey and an analysis of online patient activity.

Participants: Premenopausal women (aged 20-45 years; N=969) were surveyed in the USA, the UK, Germany, France, Italy and Spain. Rheumatologists were surveyed in Germany (N=50), France (N=50), Italy (N=50) and the USA (N=100), and gastroenterologists were also surveyed in the USA (N=100).

Primary and secondary outcome measures: Two online surveys were undertaken to identify FPP issues for physicians and patients. The surveys examined the frequency of dialogue on these topics between physicians and patients, alongside assessment of patient satisfaction regarding these conversations. Online analysis identified key themes for patient discussion outside their doctors' office/clinic/surgery.

Results: 32-56% of physicians spontaneously reported having talked about FPP with their female patients of childbearing age. When prompted, the majority of rheumatologists (74-92%) and gastroenterologists (74%) reported having discussed conception/pregnancy with female patients; however, less than half reported consulting their patient's treating general practitioner/gynaecologist about these topics. The majority of patients reported their FPP-related concerns are not adequately addressed/settled during their medical appointments. Furthermore, only 30-40% of patients considered advice/information to be consistent across multiple healthcare professionals. Key online FPP-related patient discussions included disease state, adverse effects, treatment, switch behaviour and wash-out requirements.

Conclusions: Female patients who live with chronic inflammatory disease have important FPP concerns. The majority of patients, however, do not feel that their FPP concerns are adequately addressed in current clinical practice and report that they receive inconsistent advice from the various healthcare professionals who manage different aspects of their care. There is a clear need for provision of up-to-date and consistent information/support to female patients.

Keywords: Autoimmune disease; Family Planning; Inflammatory disease; Pregnancy.

Figure 1

Frequency of physician-initiated discussions regarding family planning and pregnancy issues with female patients and their general practitioners or gynaecologists (survey phase 2 data shown in B and C). Ga, gastroenterologist; Rh, rheumatologist. *p<0.05 compared to phase 1 (two-sided z-test with significance level 0.05).

Figure 2

Patient-reported (patient survey) topics of discussion with specialist physicians, the frequency of patient-initiated family planning and pregnancy (FPP) discussion and the importance of FPP issues stratified by patient age (data from survey phase 2 shown in C).

Figure 3

Patient preference for frequency of discussions relating to family planning and pregnancy issues and identification of issues that prevented discussion (data from patient survey phase 2 shown).

Figure 4

Patient preference for choice of healthcare provider for discussions of their condition and family planning and pregnancy (FPP) issues, and their preferred source of additional information (outside doctors’ office/clinic/surgery) relating to their condition and FPP issues (data from patient survey phase 2 shown). GP, general practitioner.

Figure 5

Family planning and pregnancy-related considerations for practicing physicians treating female patients of childbearing age who live with chronic inflammatory disease: key messages from the survey of current clinical practice and patient perceptions.