Brooke S Mills1,2, Kathryn H Dao3,4, Kristen M Tecson3,4, Emily F Beil3,4, Rachel Tate3,4, John J Cush3,4. 1. From the University of Texas Southwestern; Baylor Research Institute; Baylor Heart and Vascular Institute; Texas A&M HSC College of Medicine, Dallas, Texas, USA. brooke.mills@phhs.org. 2. B.S. Mills, MD, University of Texas Southwestern; K.H. Dao, MD, Baylor Research Institute; K.M. Tecson, PhD, Baylor Research Institute, and Baylor Heart and Vascular Institute; E.F. Beil, MD, Texas A&M HSC College of Medicine; R. Tate, MD, Baylor Research Institute; J.J. Cush, MD, Baylor Research Institute. brooke.mills@phhs.org. 3. From the University of Texas Southwestern; Baylor Research Institute; Baylor Heart and Vascular Institute; Texas A&M HSC College of Medicine, Dallas, Texas, USA. 4. B.S. Mills, MD, University of Texas Southwestern; K.H. Dao, MD, Baylor Research Institute; K.M. Tecson, PhD, Baylor Research Institute, and Baylor Heart and Vascular Institute; E.F. Beil, MD, Texas A&M HSC College of Medicine; R. Tate, MD, Baylor Research Institute; J.J. Cush, MD, Baylor Research Institute.
Abstract
OBJECTIVE: The Pregnancy and Lactation Autoimmune Network (PLAN) registry was established to evaluate the concerns of women with autoimmune or inflammatory rheumatic diseases (AIRD) pertaining to pregnancy and lactation. METHODS: The registry was started as a survey of patients with AIRD at a single rheumatology specialty center in November 2016 and included questions regarding fertility, pregnancy, miscarriages, and lactation before and after diagnosis. RESULTS: The study included 154 subjects from the PLAN registry. More than half (52%) of respondents indicated that their diagnosis negatively changed their views on pregnancy and nearly a third (30%) decided not to have children after AIRD diagnosis. Most (66%) women were concerned that medication use during the childbearing process would affect the baby. One-third (34%) indicated their views on breastfeeding negatively changed as a result of their disease diagnosis. The rates and duration of breastfeeding did not differ significantly for babies born before or after the mothers' diagnosis (p = 0.50 and p = 0.21, respectively). Eighteen women in our study avoided breastfeeding or stopped breastfeeding earlier than planned to start a medication (including etanercept, adalimumab, hydroxychloroquine, and certolizumab) they believed to be contraindicated during lactation. The PLAN registry included 19 women who breastfed 22 babies while being exposed to a disease-modifying antirheumatic drug or biologic. None of these 19 women reported a delay in their children's developmental milestones or higher infection rates. CONCLUSION: This study highlights an unmet need in patients with AIRD of childbearing potential for data and education regarding pregnancy and lactation.
OBJECTIVE: The Pregnancy and Lactation Autoimmune Network (PLAN) registry was established to evaluate the concerns of women with autoimmune or inflammatory rheumatic diseases (AIRD) pertaining to pregnancy and lactation. METHODS: The registry was started as a survey of patients with AIRD at a single rheumatology specialty center in November 2016 and included questions regarding fertility, pregnancy, miscarriages, and lactation before and after diagnosis. RESULTS: The study included 154 subjects from the PLAN registry. More than half (52%) of respondents indicated that their diagnosis negatively changed their views on pregnancy and nearly a third (30%) decided not to have children after AIRD diagnosis. Most (66%) women were concerned that medication use during the childbearing process would affect the baby. One-third (34%) indicated their views on breastfeeding negatively changed as a result of their disease diagnosis. The rates and duration of breastfeeding did not differ significantly for babies born before or after the mothers' diagnosis (p = 0.50 and p = 0.21, respectively). Eighteen women in our study avoided breastfeeding or stopped breastfeeding earlier than planned to start a medication (including etanercept, adalimumab, hydroxychloroquine, and certolizumab) they believed to be contraindicated during lactation. The PLAN registry included 19 women who breastfed 22 babies while being exposed to a disease-modifying antirheumatic drug or biologic. None of these 19 women reported a delay in their children's developmental milestones or higher infection rates. CONCLUSION: This study highlights an unmet need in patients with AIRD of childbearing potential for data and education regarding pregnancy and lactation.