Rheumatology, Duke University School of Medicine, Durham, North Carolina, USA
Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.
Lupus Sci Med. 2024 Aug 24;11(2):e001192. doi: 10.1136/lupus-2024-001192.
Contraception is crucial for safely timing pregnancies in patients with SLE. This study investigated predictors of contraception documentation in patients with SLE, and the alignment of contraception practices with the 2020 American College of Rheumatology (ACR) guidelines, within the Rheumatology Informatics System for Effectiveness (RISE) registry.
Female patients (aged 18-44 years) with SLE were identified via International Classification of Diseases (ICD)-9/ICD-10 coding within the RISE registry, which includes data from rheumatology clinics across the USA. Eligible patients were required to have ≥1 clinical visit in 2019 (prepandemic) or between 1 April 2020 and 30 March 2021 (mid-pandemic). Adjusted multilevel logistic modelling assessed patient, provider and practice characteristics for associations with contraception documentation. Contraception patterns were identified and compared with the 2020 ACR guidelines.
Contraception documentation rates were similar in the prepandemic and mid-pandemic groups (8.1% and 8.5%, respectively). Higher documentation rates were found in women who were younger, White, and had more visits, as well as those seen within a health system, by a female provider, and within specific regions and electronic health record (EHR) systems. Prescription of a teratogenic medication did not influence contraception documentation or type. Oestrogen-containing contraceptives were prescribed less often to women at high risk for thrombosis (26.2% with thrombotic risk vs 60.6% without, p<0.0001) and history of lupus nephritis (LN) (53.8% with history of LN vs 63.2% without, p=0.024).
Practices participating in the RISE registry do not currently record contraception in the large majority of women with SLE, although increased documentation in some EHRs suggests that system changes may improve rates of documentation. Women at higher risk for thrombosis were less likely to receive oestrogen, suggesting that warnings against oestrogen use has impacted contraception prescription, although the limited documentation and limited contraception among women taking teratogenic medications suggest a high unmet need.
避孕对于安全控制 SLE 患者的妊娠时间至关重要。本研究调查了 SLE 患者避孕记录的预测因素，以及避孕实践与 2020 年美国风湿病学会 (ACR) 指南的一致性，该研究在风湿病信息系统有效性 (RISE) 登记处进行。
通过 RISE 登记处的国际疾病分类 (ICD)-9/ICD-10 编码确定 SLE 女性患者，该登记处包括来自美国各地风湿病诊所的数据。符合条件的患者需要在 2019 年（大流行前）或 2020 年 4 月 1 日至 2021 年 3 月 30 日（大流行中期）期间至少有 1 次就诊记录。采用调整后的多级逻辑模型评估患者、提供者和实践特征与避孕记录的关联。确定避孕模式并将其与 2020 年 ACR 指南进行比较。
大流行前和大流行中期组的避孕记录率相似（分别为 8.1%和 8.5%）。在较年轻、白人、就诊次数较多的患者中，以及在医疗系统内、由女性提供者就诊的患者中，以及在特定地区和电子健康记录 (EHR) 系统中，记录率更高。开处致畸药物并不会影响避孕记录或类型。具有血栓形成风险（血栓形成风险患者中有 26.2%使用雌激素，无血栓形成风险患者中有 60.6%使用雌激素，p<0.0001）和狼疮肾炎 (LN) 病史（有 LN 病史患者中有 53.8%使用雌激素，无 LN 病史患者中有 63.2%使用雌激素，p=0.024）的女性使用雌激素避孕药的频率较低。
参与 RISE 登记处的实践目前并未在大多数 SLE 女性中记录避孕情况，尽管某些 EHR 中记录的增加表明系统变化可能会提高记录率。具有较高血栓形成风险的女性不太可能接受雌激素，这表明对雌激素使用的警告影响了避孕处方，尽管接受致畸药物治疗的女性避孕记录有限且避孕措施有限，但表明存在未满足的高需求。
