Advising patients with systemic lupus erythematosus (SLE) on issues related to contraception, pregnancy, and lactation can be difficult. In a continuing effort to improve care of lupus patients during their reproductive years, three experts during a Sunday session will discuss these issues and offer practical strategies to help clinicians feel more comfortable with reproductive health management.
Transform SLE Pregnancies: Prepared Providers, Empowered Patients will take place from 8:30 – 10:00 am Sunday in room B211-B212 in Building B of the Georgia World Congress Center.
Presenter Bonnie Bermas, MD, Professor of Medicine at the University of Texas Southwestern Medical Center, Dallas, said rheumatologists are often out of their comfort zone when discussing family planning with patients.
“We hope to educate providers about contraception and medication use during pregnancy and lactation in SLE patients so that they can be more comfortable managing their patients’ family planning and pregnancies,” Dr. Bermas said.
The session will begin with a talk on contraception and fertility by Mehret Birru-Talabi, MD, PhD, Co-Director of the Rheumatology Fellowship Training Program at the University of Pittsburgh Medical Center, Pennsylvania.
“Rheumatologists should understand that many patients with SLE may want to have pregnancies no matter what the potential risk is to their health,” Dr. Birru-Talabi said. “The goal is to ameliorate those modifiable risk factors and educate patients about their risks in advance of pregnancy to give them the best chance of having successful and healthy outcomes.”
In addition to discussing contraception for prevention when necessary, she will discuss assisted reproductive technologies, which she said appear to be safe and effective for women with SLE.
Next, Dr. Bermas will provide up-to-date information on medication safety during pregnancy and lactation.
“If providers come away with one pearl, I hope it would be that in an ideal world, all SLE pregnancies would be planned for when a patient’s disease is under good control and patients are on medications compatible with pregnancy,” she said.
To make such planning discussions easier for providers, Megan Clowse, MD, MPH, Associate Professor of Medicine at Duke University School of Medicine, Durham, North Carolina, will then present “Honest and Accurate Conversations to Plan Lupus Pregnancies.”
“The goal is really to improve the ability of rheumatologists across the country and the world to be able to provide high-level care to women with lupus during pregnancy,” Dr. Clowse said. “Proper planning can improve pregnancy outcomes and decrease pregnancy loss and complications, such as preterm birth. We can also reduce disease activity during pregnancy with appropriate prevention of pregnancy when it’s necessary and carefully planning and managing pregnancy when it’s not.”
Dr. Clowse’s talk will center on a practical tool she’s developed to help rheumatologists have straight-forward conversations with patients about pregnancy planning.
“We’ve developed a website, as well as a handout that guides clinicians and the patient through the conversation together,” she said. “It guides physicians through all the things they need to discuss with patients about planning pregnancy and provides the actual information the doctor needs to answer patient questions. It’s right there on the page.”
Dr. Clowse said her talk would function almost like a workshop.
“We’ll share the handout and review how to ask the questions and how to present the information to patients,” she said. “Rheumatologists don’t commonly use a handout to guide a clinical conversation, so it can feel kind of awkward. I have this conversation at least three times a week with patients, and I find the handout very useful. My goal is to get clinicians past the skepticism and on to enthusiasm about using the handout to guide pregnancy planning.”
The tool and more information about medication safety during pregnancy and lactation can be found at www.lupuspregnancy.org. In addition, the ACR’s clinical practice guideline, “Reproductive Health in Rheumatic Diseases,” is nearing publication and is expected to be available soon.