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Contraception Counseling in Patients With SLE and Other Chronic Medical Conditions Requiring Potentially Teratogenic MedicationsA Teachable Moment

Educational Objective
To review the importance of contraception counseling in patients with systemic lupus erythematosus and other chronic medical conditions requiring potentially teratogenic medications and outline the means to overcome the present barriers to such counseling.
1 Credit CME

A sexually active young woman with systemic lupus erythematosus (SLE) complicated by lupus nephritis was hospitalized for a lupus flare after discontinuing treatment with her medications. The patient had been diagnosed in her teens and received induction therapy with cyclophosphamide followed by maintenance therapy with mycophenolate mofetil. Despite being sexually active, she reported no contraceptive counseling at the time of diagnosis or prior to initiation of treatment with potentially teratogenic medications.

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Article Information

Corresponding Author: Ann Cameron Barr, BA, c/o Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Dr SE, Atlanta, GA 30329 (ann.cameron.barr@emory.edu).

Published Online: January 28, 2019. doi:10.1001/jamainternmed.2018.7990

Conflict of Interest Disclosures: None reported.

Additional Information: Ms Barr performed the literature search, wrote the initial draft, and incorporated suggested edits from Drs Badell and Vettese. She was a fourth-year medical student at the time the manuscript for this article was prepared.

References
1.
Curtis  KM, Tepper  NK, Jatlaoui  TC,  et al.  U.S. Medical eligibility criteria for contraceptive use, 2016.  MMWR Recomm Rep. 2016;65(3):1-103. doi:10.15585/mmwr.rr6503a1PubMedGoogle ScholarCrossref
2.
Yazdany  J, Trupin  L, Kaiser  R,  et al.  Contraceptive counseling and use among women with systemic lupus erythematosus: a gap in health care quality?  Arthritis Care Res (Hoboken). 2011;63(3):358-365.PubMedGoogle Scholar
3.
Ferguson  S, Trupin  L, Yazdany  J, Yelin  E, Barton  J, Katz  P.  Who receives contraception counseling when starting new lupus medications? the potential roles of race, ethnicity, disease activity, and quality of communication.  Lupus. 2016;25(1):12-17. doi:10.1177/0961203315596079PubMedGoogle ScholarCrossref
4.
Eisenberg  DL, Stika  C, Desai  A, Baker  D, Yost  KJ.  Providing contraception for women taking potentially teratogenic medications: a survey of internal medicine physicians’ knowledge, attitudes and barriers.  J Gen Intern Med. 2010;25(4):291-297. doi:10.1007/s11606-009-1215-2PubMedGoogle ScholarCrossref
5.
Lee  JK, Parisi  SM, Akers  AY, Borrero  S, Schwarz  EB.  The impact of contraceptive counseling in primary care on contraceptive use.  J Gen Intern Med. 2011;26(7):731-736. doi:10.1007/s11606-011-1647-3PubMedGoogle ScholarCrossref
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