Background An estimated half of all pregnancies in the US are unplanned. In general, unplanned pregnancies are at higher risk for pregnancy loss and birth defects; an estimated 1/3 are electively terminated. Among women with rheumatic disease, the risks of unplanned pregnancy are even higher due to the frequent use of teratogenic medications and complications from active disease at conception. We sought to determine the frequency of unplanned pregnancy and the demographic differences between planned and unplanned pregnancies in a university-based pregnancy and rheumatology clinic.
Methods At enrollment into a prospective rheumatology pregnancy cohort, each woman completed the London Measure of Unplanned Pregnancy (LMUP), a validated 6-question survey that assesses a womans intentions for conception. Demographic and historical rheumatologic data were collected. A higher LMUP score indicated a higher degree of pregnancy planning; a planned pregnancy has a score of 10–12.
Results Eighty-two pregnant women completed the survey between January and December 2018. The majority of women were white (68%), well-educated (77% at least college educated), married (77%), and had private insurance (77%); the average age was 30.7. The most common diagnosis was SLE (26%), followed by RA (21%) and UCTD (18%).
The median LMUP score was 11 with 71% of women having a planned pregnancy. Of the women with an unplanned pregnancy, only 37% reported contraceptive use, including progesterone-only pill (8%), IUD (4%), and barrier methods (25%). No differences in contraception use between women with and without SLE were observed.
In comparison to women without SLE, those with SLE were more likely to have an unplanned pregnancy (25% without SLE vs 43% with SLE, p=0.2) The LMUP score was significantly lower for women with SLE (mean 10.3 non-SLE vs 9.0 SLE, p=0.07; median 12.0 non-SLE vs 10.0 SLE, p=0.01). Only 43% of women with SLE reported that they had intended to get pregnant, compared to 75% of non-SLE women (p=0.02) and 48% of women with SLE reported taking folic acid or a prenatal vitamin compared to 72% of non-SLE women (p=0.06)
Conclusions Among this largely upper-middle and middle class population, most pregnancies were planned and most women took steps pre-pregnancy to prepare; this data may not reflect the typical rheumatology clinic. Among women with SLE, however, a higher proportion of pregnancies were unplanned. Our next steps will be to correlate pregnancy intention with outcomes and implement approaches to limit unplanned pregnancies among women with SLE.
Funding Source(s): None
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