Al-Husayni Noor, Maslyanskaya Sofya, Rubinstein Tamar B, Coupey Susan M
Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, NY.
Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, NY; Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
J Pediatr. 2023 Feb;253:252-258. doi: 10.1016/j.jpeds.2022.09.052. Epub 2022 Oct 5.
To describe female adolescents' reproductive health needs and subspecialists' teratogenic counseling at initiation of mycophenolate as well as use of reproductive health care and contraception after mycophenolate initiation.
We searched health records for female patients aged 12-20 years prescribed mycophenolate from 2010 to 2019. We included 125 subjects, 72 with systemic lupus erythematosus, 27 with transplants, and 26 with other conditions. We reviewed all encounters with pediatric subspecialists and reproductive clinicians. We recorded counseling by subspecialists at mycophenolate initiation and compared rates pre- and post-Risk Evaluation and Mitigation Strategy (REMS). We recorded subjects' menstrual, sexual and pregnancy history, type of first highly effective contraceptive method used, and duration of use over the decade.
At mycophenolate initiation, mean age was 16.8 ± 2.6 years; 72% Hispanic/Latina or Black. In total, 80% were postmenarchal, 28% ever had sex, 18% ever had a reproductive health care visit, 14% used highly effective contraception, and 7% were ever pregnant. Post-REMS vs pre-REMS, we found greater rates of counseling for teratogenicity (68% vs 32%, P < .001) and contraception (62% vs 32%, P < .001) and pregnancy testing (51% vs 24%, P < .01). Over the mean 4.9 ± 3.3 years' follow-up, 56% ever had sex; 59% ever attended a reproductive health care visit; 38% used highly effective contraception; and 10% had a pregnancy.
Adolescents prescribed mycophenolate have ongoing unmet reproductive health care needs. Although many are sexually active, fewer use effective contraception. Teratogenicity counseling rates improved over the decade but not rates of referral for reproductive health care.
描述女性青少年的生殖健康需求以及专科医生在开始使用霉酚酸酯时进行的致畸性咨询，以及开始使用霉酚酸酯后生殖健康护理和避孕措施的使用情况。
我们检索了2010年至2019年期间为12至20岁女性患者开具霉酚酸酯的健康记录。我们纳入了125名受试者，其中72名患有系统性红斑狼疮，27名接受了移植手术，26名患有其他疾病。我们回顾了与儿科专科医生和生殖科临床医生的所有会诊情况。我们记录了专科医生在开始使用霉酚酸酯时提供的咨询，并比较了风险评估和缓解策略（REMS）实施前后的咨询率。我们记录了受试者的月经、性和怀孕史、首次使用的高效避孕方法类型以及十年内的使用时长。
开始使用霉酚酸酯时，平均年龄为16.8±2.6岁；72%为西班牙裔/拉丁裔或黑人。总体而言，80%已初潮，28%曾有过性行为，18%曾接受过生殖健康护理，14%使用高效避孕措施，7%曾怀孕。与REMS实施前相比，REMS实施后，我们发现致畸性咨询率（68%对32%，P<.001）、避孕咨询率（62%对32%，P<.001）和妊娠检测率（51%对24%，P<.01）更高。在平均4.9±3.3年的随访中，56%曾有过性行为；59%曾接受过生殖健康护理；38%使用高效避孕措施；10%怀孕。
开具霉酚酸酯的青少年仍有未满足的生殖健康护理需求。尽管许多人有性行为，但使用有效避孕措施的人较少。十年来致畸性咨询率有所提高，但生殖健康护理转诊率未提高。
