Background The inflammatory arthritis (IA) - rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and juvenile idiopathic arthritis (JIA) - affect a significant number of women of childbearing age. Epidemiological studies have shown that the number of births is lower in these patients compared with healthy controls, but the fertility rate is not always decreased. Personal choice of family planning in these patients is influenced by several factors, such as disease activity, use of potentially teratogenic drugs, functional impairment and information received.
Objectives To assess the aspects related to the disease that have greater impact on family planning in women with IA and identify areas for improvement from the point of view of the patient.
Methods We performed a cross-sectional study in women with IA (RA, AS, PsA and JIA) of childbearing age (17–47 years) during the period from June 2014 to July 2015. Two anonymous questionnaires were used for data collection, a questionnaire included clinical data and was completed by the physician and another questionnaire with demographic data, reproductive history and family planning was completed by the patient. Family planning assessment included 16 closed-ended questions about influence of disease activity, secondary concerns and fears, knowledge on diagnosis, treatment and its effects on pregnancy, and information provided by her rheumatologist. All patients signed an informed consent.
Results A total number of 108 women were included. The mean age was 37.4±7.5 years and their diagnoses were: RA 43, AS 31, PsA 19 and JIA 16. The mean age at diagnosis was 27.7±10.2 years and 54% had children (0.82 children/woman). 33% of patients had been a mother before diagnosis and only 20% later (0.24 children/woman), although 40% had considered pregnancy during the disease. IA was considered a conditioning factor for family planning in 70% of cases, and the disease activity was chosen as the most influential factor followed by the treatment. Concerns about disease worsening was found in 64%, transmission of IA to their children in 48% and limitation for care them adequately due to functional impairment in 45%. Half of the patients reported having little knowledge about side effects of drugs on the mother or fetus and have received none or scarce information about pregnancy and breastfeeding from their rheumatologists in 52% and 68%, respectively. More than a third of the patients had considered a new pregnancy if they had received more information. There was no relationship with socio-demographic variables and no significant differences were found in the subgroup analysis (IA type, age, treatment).
Conclusions Women with IA have a low birth rate. The factors with a greater impact in family planning were disease activity and treatment, but were also important the fear of worsening, disease transmission and not be able to care for children properly. Lack of knowledge and information needs to be detected in these patients and should be resolved since the diagnosis. A better understanding of their disease could help these patients to diminish their fears and facilitate family planning in those who wish it.
Disclosure of Interest None declared
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