Assess Reproductive Health in SLE Clinic Visits Save

SLE predominantly affects women of childbearing age. Women affected by SLE have a higher risk for infertility, miscarriages, and other pregnancy complications due to disease activity, renal involvement, medications, and presence of certain autoantibodies. Due to the complexity of SLE, rheumatology providers should take an active role in assessing reproductive health, providing education on how SLE may affect pregnancy, and taking a collaborative, multidisciplinary approach with the patient’s gynecologist. Most importantly, studies have shown that patients desire an active role from their rheumatologist regarding initiating family planning conversations and sexual/reproductive health education. 

During clinic visits, providers should routinely assess a patient's desire for future pregnancies and/or contraception options. These open discussions actively engage and empower patients in their own care and improve overall outcomes. Reproductive health is an important topic that should be a shared decision-making process between SLE patients and providers to improve overall quality of life. 

Providers can use the HOP-STEP (Health Outcomes in Pregnancy with SLE through Education of Providers) approach created by Duke University of Medicine. The HOP-STEP checklist allows providers to address disease activity, medication compatibility, autoantibodies, and contraception options with the patients. 

Active SLE at the time of conception is a strong predictor of adverse maternal and fetal outcomes; current recommendations include attempting disease quiescence for 6 months before trying to conceive. Medication list should be checked for pregnancy compatibility and if necessary, patient care centered decision making plans should be established to switch from non-compatible medications to compatible medications. Autoantibodies such as anti- Ro/SSA, anti-La/SSB, antiphospholipid antibodies have specific risks during pregnancies, including birth defects to the fetus, and patients with these antibodies require careful monitoring during pregnancy. 

If patients choose contraception, providers should discuss types of contraception acceptable for SLE along with contraception that is the most effective and safest. Pregnancy in SLE should be planned due to disease activity and certain medications for treatment of SLE that are teratogenic. 

In summary, rheumatology providers should routinely address reproductive health such as desires for future pregnancy or appropriate contraception options for SLE. They may use the HOP-STEP approach and discuss SLE disease activity, medication compatibility, and autoantibodies and how they may affect pregnancy outcomes. 

HOP-STEP ref: Sims CA, et al. The impact of pregnancy planning and medical readiness on reproductive outcomes in women with systemic lupus erythematosus. Lupus. 2023 Dec;32(14):1666-1674. 

This research was supported by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health, Bethesda, Maryland, USA. The contributions of the NIH author(s) were made as part of their official duties as NIH federal employees, are in compliance with agency policy requirements, and are considered Works of the United States Government. However, the findings and conclusions presented in this paper are those of the author(s) and do not necessarily reflect the views of the NIH or the U.S. Department of Health and Human Services.