Contraceptive counseling and use among women with systemic lupus erythematosus: A gap in health care quality?

Systemic lupus erythematosus (SLE) disproportionately affects women of reproductive age, making issues surrounding pregnancy and contraception an important part of clinical care for this population. Although individuals with SLE have an increased risk of complications during pregnancy, growing evidence suggests that carefully planned pregnancies that occur during times of disease quiescence may portend better outcomes for both the mother and fetus (1–3). In addition, because many medications used to treat SLE have significant teratogenic potential, use of effective contraception is imperative when pregnancy is not planned. In recent years, the approach to contraception in SLE has seen significant progress, largely because of important clinical trials demonstrating that many contraceptive methods are safe in this patient population. Previous research had suggested that hormonal agents might increase the risk of disease flares (4, 5). However, two randomized trials found no increase in flares in those without severe disease flares at study entry (6, 7). A recent systematic review also concluded that available evidence suggests that benefits of use outweigh potential risks for most contraceptive methods in women with SLE (8). Given these advances in understanding the safety of contraceptive options for women with SLE and growing evidence that carefully planning for pregnancy to occur during times of disease quiescence improves maternal and fetal health outcomes (3), we investigated both the use of contraceptives and the receipt of contraceptive counseling in a large, observational study of women with SLE.