title: Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality?
abstract: OBJECTIVE
  Disease activity and medication use can complicate pregnancies in patients with systemic lupus erythematosus (SLE). We therefore examined contraceptive counseling and use among women in the University of California, San Francisco Lupus Outcomes Study.
  
  
  METHODS
  In 2008, we queried participants regarding their pregnancy intentions, contraceptive use, and receipt of contraceptive counseling. Premenopausal women age <45 years who were sexually active with men were considered at risk of pregnancy. We compared self-reported rates of contraceptive counseling and use stratified by treatment with teratogenic medications and by history of thrombosis or antiphospholipid antibodies (aPL), using chi-square tests. We used logistic regression models to examine predictors of contraceptive counseling and use.
  
  
  RESULTS
  Among 206 women, 86 were at risk for unplanned pregnancy. Most (59%) had not received contraceptive counseling in the last year, 22% reported inconsistent contraceptive use, and 53% depended solely on barrier methods. Intrauterine device contraceptives (IUDs) were used by 13%. Women using potentially teratogenic medications were no more likely to have received contraceptive counseling, to have used contraception consistently, or to have used more effective contraceptives. A history of thrombosis or aPL did not account for low rates of hormonal methods. Four women with a history of thrombosis or aPL were using estrogen-containing contraceptives.
  
  
  CONCLUSIONS
  Most women at risk for unplanned pregnancy reported no contraceptive counseling in the past year, despite common use of potentially teratogenic medications. Many relied upon contraceptive methods with high failure rates; few used IUDs. Some were inappropriately using estrogen-containing contraceptives. These findings suggest the need to improve the provision of contraceptive services to women with SLE.
authors.affiliation: University of California, San Francisco, 94143, USA. jinoos.yazdany@ucsf.edu
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.forename: Rachel
authors.initials: R
authors.lastname: Kaiser
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.forename: Joann Zell
authors.initials: JZ
authors.lastname: Gillis
authors.forename: Eliza
authors.initials: E
authors.lastname: Chakravarty
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D016009:Chi-Square Distribution; D003267:Contraception / Q000379:methods*; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016015:Logistic Models; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D016017:Odds Ratio; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D018570:Risk Assessment; D012307:Risk Factors; D012495:San Francisco; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents