Background For years, women with potentially serious systemic diseases, such as rheumatic diseases (RD), have been advised against getting pregnant. However, with careful clinical management, most of these women can have successful pregnancies. The use of RD drugs before or during pregnancy is problematic due to the lack of knowledge about their compatibility with pregnancy. Recently, the British Society of Rheumatology (BSR) and the European League Against Rheumatism (EULAR) published guidelines on prescribing drugs in pregnancy and breastfeeding.
Objectives To evaluate the perceptions and clinical practices of rheumatologists and obstetricians in Lebanon regarding the use of medications prior and during pregnancy and breastfeeding. The secondary objective was to assess the variables that are significantly associated with the physicians' adherence to guidelines.
Methods A national, observational, cross-sectional physician survey was conducted among a representative sample of rheumatologists and obstetricians throughout Lebanon. Collected data included physicians' information (age, gender, years of experience, practice setting and number of pregnant patients with RD seen per month), their opinion on pregnancy in RD patients (pre-conception status of RD and counseling, remission length before allowing pregnancy) and compatible RD drugs with pregnancy and lactation. Qualitative variables were analyzed using Chi-square or Fisher's exact tests, while quantitative variables were analyzed using Wilcoxon or Student t tests. A total score of answers per physician in accordance with EULAR/BSR guidelines was calculated. Univariate and multivariate analysis assessed the variables significantly associated with this score. P value <0.05 indicated statistical significance.
Results Thirty-nine (90.7%) rheumatologists participated in this survey. They had 22.2±11.6 years of practice. Ninety-four (41.4%) obstetricians participated in this survey. They had 26.0±12.8 years of practice. Figure 1 displays the percentage of physicians who consider the selected RD medications detrimental to/not compatible with fertility, pregnancy and breastfeeding.
Average score of answers in accordance with EULAR/BSR guidelines was 0.654±0.154 and results were significantly different between specialties (p<0.001): rheumatologists scored between 0.41 and 1, with an average of 0.777±0.152 and obstetricians scored between 0.36 and 1 with an average of 0.603±0.124. Multivariable analysis showed that the scores reflecting adherence to recommendations were significantly associated with type of specialty (rheumatology v/s obstetrics) and number of pregnant patients with RD seen per month.
Conclusions Advices given to RD patients who plan on becoming pregnant in Lebanon vary largely, especially among the physicians' specialty and experience in RD, which highlights the urgency of disseminating the EULAR/BSR guidelines among rheumatologists and obstetricians alike.
Flint J et al, Rheumatology 2016.
Götestam Skorpen C et al, Ann Rheum Dis 2016.
Panchal S et al, Rheum Int 2013.
Ruiz-Irastorza G and Khamashta MA, ACR 2014.
Acknowledgements Sponsor: Newbridge Pharmaceuticals. MW support: KBP-Biomak.
Disclosure of Interest None declared