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. 2021 Jul;3(7):475-483.
doi: 10.1002/acr2.11240. Epub 2021 Jun 11.

Tough Choices: Exploring Medication Decision-Making During Pregnancy and Lactation Among Women With Inflammatory Arthritis

Mehret Birru Talabi  1 , Amanda M Eudy  2 , Malithi Jayasundara  2 , Tayseer Haroun  2 , W Benjamin Nowell  3 , Jeffrey R Curtis  4 , Rachelle Crow-Hercher  3 , Whitney White  3 , Seth Ginsberg  3 , Megan E B Clowse  2
Affiliations

Tough Choices: Exploring Medication Decision-Making During Pregnancy and Lactation Among Women With Inflammatory Arthritis

Mehret Birru Talabi et al. ACR Open Rheumatol. 2021 Jul.

Abstract

Objective: This study explored how women's beliefs about drug safety and interactions with their health care providers influenced their decisions to continue arthritis medications during pregnancy and lactation.

Methods: We collaborated with ArthritisPower, a patient-powered research network, and CreakyJoints, its partner online community, to develop and disseminate a survey among members with inflammatory arthritis who had at least one pregnancy after diagnosis. Participants' free-text responses were evaluated by using thematic analysis.

Results: Women in the sample were 40 years old on average (N = 66). Nineteen of their pregnancies had ended in fetal loss. Fifteen percent of all pregnancies were exposed to methotrexate. Among women who used safe arthritis medications, up to 80% discontinued treatment either in preparation for pregnancy or during pregnancy or lactation. Women's decisions to continue medications during pregnancy were influenced by their perceptions of safety and advisement from health care providers, although they often described that advice about medication safety was inconsistent between providers.

Conclusion: Women often chose to endure active inflammatory arthritis rather than to use disease-modifying antirheumatic drugs because of concerns about medication safety during pregnancy and lactation. Conflicting medical advice from health care providers undermined patients' trust in their providers and in the safety of their medications. The high rate of peripartum exposure to methotrexate, a fetotoxic drug, underscores the need for better family planning care for women with childbearing potential.

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Figures

Figure 1
Figure 1
Associations between medication continuation, medication discontinuation, and pregnancy in the sample. a One patient reported taking MTX in pregnancy and had a pregnancy loss; she did not report stopping the MTX. HCQ, hydroxychloroquine; MTX, methotrexate; NSAID, nonsteroidal anti‐inflammatory drug; TNFi, tumor necrosis factor α inhibitor.
Figure 2
Figure 2
Medication use among lactating women (n = 37). HCQ, hydroxychloroquine; NSAID, nonsteroidal anti‐inflammatory drug; TNF, tumor necrosis factor α.
Figure 3
Figure 3
Online and other resources for women seeking information on medication safety during pregnancy and lactation.
See this image and copyright information in PMC

References

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