'Paucity of data,' no guidance on induced abortion in patients with rheumatic diseases
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Significant knowledge and research gaps are making it difficult to provide evidence-based recommendations on induced abortion to patients with rheumatic disease, according to a review article published in Arthritis Care & Research.
The authors noted that patients with rheumatic disease may choose to undergo an abortion for a variety of reasons, including significant health risks and adverse pregnancy outcomes, either due to their condition, use of teratogenic drugs or personal factors. The high percentage of patients with systemic lupus erythematosus at risk for unplanned pregnancy underscores the need to better reproductive planning and contraception counseling in rheumatology, they added.
“Rheumatic diseases disproportionally affect women during their reproductive years and are associated with maternal and fetal adverse outcomes during pregnancy,” Évelyne Vinet MD, PhD, of McGill University, in Montreal, told Healio Rheumatology. “Some patients with rheumatic diseases might undergo pregnancy termination. Yet, there are no published recommendations to guide health care professionals in counseling rheumatic disease patients regarding pregnancy termination.”
To provide an overview of the considerations health care professionals “must take into account” when caring for patients with rheumatic diseases who are considering abortion, Vinet and colleagues reviewed the available literature.
According to the authors, data on the safety and best practice of induced abortion in patients with rheumatic disease is “sparse.” However, patients and providers may eventually face the prospect of pregnancy termination, they wrote.
“However, pregnancy termination discussions are complex and necessitate an understanding of the patient’s personal values as well as risks and benefits,” Vinet and colleagues wrote. “In case of pregnancy continuation, a multidisciplinary team should work on optimizing maternal and fetal outcomes.”
In addition, rheumatologists and other providers should be informed about various induced abortion methods, including medication and surgery, according to the authors. They added that, although one method may be recommended, “it is ultimately the patient who decides which method to pursue, as patient choice and autonomy are strong predictors of patient satisfaction.”
Lastly, Vinet and colleagues detailed several special considerations regarding abortion in patients with rheumatic diseases. These include the risk for bleeding among patients on anticoagulants or with a bleeding diathesis, interactions with steroids and other medications, the risk for infection among the immunosuppressed, and medication abortion in women with hypercoagulable state.
However, the lack of data regarding some of these topics makes counseling patients, and making recommendations, difficult, the authors wrote. For example, there is no data on infection rates among patients who are immunosuppressed following medication or surgical abortion. This information could assist in decisions regarding the best type of abortion for these patients.
In addition, although hypercoagulable conditions, such as antiphospholipid syndrome, have been associated with an increased incidence of adverse pregnancy outcomes, there are no data presently available to guide decisions about abortion methods for these patients.
“Although there is a large body of literature on pregnancy and rheumatic diseases, there is a paucity of data on pregnancy termination,” Vinet said. “However, recent evidence suggests that patients with rheumatic diseases have a similar frequency of induced abortion than women from the general population. We highlight key areas related to pregnancy termination in rheumatic diseases that require further studies and the importance of pregnancy planning and contraception counselling in women with rheumatic diseases.”
“Pregnant women with rheumatic diseases are a vulnerable population,” she added. “They need to be informed of adverse maternal and fetal outcomes of pregnancy to make informed reproductive decisions, which might include pregnancy terminations.”
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