‘Promoting honest and accurate conversations’ key before pregnancy in patients with ILD

Key takeaways:

• Asking women about pregnancy and birth control is important in helping them properly plan for what they want.
• Discussion guides can aid physicians in providing accurate information to patients with ILD.

BOSTON — To help patients with interstitial lung disease lower the chances of having a sick baby, physicians must have “honest and accurate conversations” with them before pregnancy, according to a presentation at the CHEST Annual Meeting.

“When I mean honest, I mean that the woman feels comfortable telling you what she wants,” Megan E.B. Clowse, MD, MPH, associate professor of medicine and population health sciences and chief of the division of rheumatology and immunology at Duke University School of Medicine, said during her presentation. “Many of our women will tell you that they are really afraid to tell their doctor that they want to have a baby.”

Clowse stated that this fear and hesitation from women may stem from the belief that their doctor will say that they should not get pregnant, so they choose to keep their plans to themselves.

Accurate information on reproductive health is the second key component in conversations that should take place prior to pregnancy between physicians and sick patients, Clowse said.

In an effort to evoke these conversations and make them become a natural part of care, Clowse highlighted an approach/intervention currently being tested that involves two simple actions: asking and discussing.

“[The asking part involves] asking women if they’re interested in pregnancy in the next year and what kind of birth control they’re using, and doing that systematically,” Clowse said. “Not just when you think of it, not just when the patient is on mycophenolate, not just when you have extra time and everything else is calm, but all the time.”

Based on data from three private rheumatology clinics, Clowse and colleagues found that the majority (90%) of women of reproductive age are not interested in pregnancy in the next year when asked by a medical assistant at check-in. However, 7% are interested and the remaining 3% said they are unsure or OK either way.

“This 3% is really foreign to doctors,” Clowse said.

“But that’s how a lot of people live ... and those folks need to know what happens if they get pregnant, the good [and] the bad,” Clowse added.

When asked about birth control, 35% reported no use, 16% reported permanent birth control, 15% reported long-acting reversible contraception, 22% reported effective hormonal contraception and 12% reported less effective birth control methods, Clowse said during her presentation. Notably, birth control use was not captured for 42% of women.

“It’s important to ask,” Clowse said.

“Sometimes I don’t ask, and I leap into this conversation and the patient’s looking at me like I’m kind of crazy because they actually are really interested in pregnancy or there’s no way they’re ever interested in pregnancy, but I’ve just done this whole song and dance about pregnancy and so on,” Clowse added. “Finding out where she is is a really excellent starting point.”

For the discussing part of the approach, Clowse and colleagues developed a discussion guide covering birth control and pregnancy for patients with rheumatic diseases that could be repurposed for ILD clinics.

On both sides of the guide, there are numbers for physicians to follow that help them provide accurate information to the patient based on what they want in terms of birth control and pregnancy.

Some key elements on the birth control side that Clowse pointed out include finding a safe birth control, information on emergency contraception and types of birth control divided according to efficacy.

On the pregnancy side of the guide, there are lists of pregnancy-compatible medications and medications that may cause birth defects. There is also a section that lists different doctors a patient should potentially speak with.

“The regular OBs are great at delivering babies, but they know very little about chronic lung disease, so having a maternal-fetal medicine doctor, I would recommend strongly,” Clowse said.

Overall, Clowse said helping women with diseases get to their healthiest and have a healthy baby is her goal, and this requires meeting three factors: planning, pregnancy-compatible medications and controlled disease.