AB1146 REAL-LIFE PRACTICES IN MANAGEMENT OF REPRODUCTIVE HEALTH IN SLE AND APS BY OBSTETRICIANS AND RHEUMATOLOGISTS IN EGYPT. (AN ONLINE-BASED QUESTIONNAIRE)

Abstract

Background: Systemic lupus erythematosus (SLE) is an auto-immune disease that affect women in their reproductive age. Antiphospholipid syndrome (APS) is a hypercoagulable immune disease that occur as a primary condition or in assosiation with SLE. The reproductive aspects as contraception, fertility, pregnancy are crucial to consider for proper management of SLE/APS. Addressing these issues require collaboration between rheumatologists and obstetricians, improving their knowledge and ensuring that both are acquainted with the updated guidelines. Objectives: To assess the knowledge and practice of Egyptian obstetricians and rheumatologists in management of reproductive health issues in SLE and APS, and to detect common misconceptions. Methods: This research was conducted via google form online survey based on points discussed in EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with SLE and/or APS.1 It was sent to target obstetricians and rheumatologists by internet clouds like (Facebook, twitter, LinkedIn) from August to November 2019. It included five domains; demographic data, general knowledge and attitudes about pregnancy in SLE and APS, contraception, drugs, and assisted reproductive techniques (ART) After submitting answers, respondents were shown a link directing them to the 2016 EULAR recommendations.1 Results: This study was conducted on 254 physicians, 62% obstetricians and 38% rheumatologists. 64.6% were between the ages of 30-35 years. For general knowledge, 52% of Obstetricians considered pregnancy in inactive SLE to be risky. (79.4% vs 54.1%) of (rheumatologists and obstetricians) respectively test for aPL in SLE patients. More than 70% in both groups were well informed on the increased rate of fetal and maternal complications in both SLE and APS. For fetal surveillance, 87% and 90% of obstetricians preformed first and second trimester U/S, and 79% preformed second trimester Doppler. For contraception, (57.7% vs 56.7%) discuss contraceptive choices with their patients. The majority considered it safe to use IUDs (73.9% vs 76%) and condoms (84.7 vs 85.4%) in both SLE and APS patients. On the other hand, for hormonal contraception-Levonorgestrol IUD, Depoprovera, COCP, and POP-only 14.6%, 22.9%, 26.1%, 24.8% of rheumatologists and 18.5%, 27.2%, 29.9%, 26.8% of obstetricians considered them unsafe to use in APS. Concerning treatment, the majority considered low dose presnidone to be safe during pregnancy (94.8 % vs 80%) and breastfeeding (87.6% vs 64.3%). The majority also agreed on avoidance of Methotrexate (94.8% vs 84.1%) and Cyclophosphamide (89.7% vs 66.2%). However, regarding Hydroxychloroquine and Azathioprine use in pregnancy there was a significant discrepancy between rheumatologists and obstetricians, (89.7 % vs 42%) and (78.4% vs 36.9%) believed them safe to use in pregnancy. For Mycophenolate Mofetil, (80.4% vs 46.5%) said that it should be avoided in pregnancy. Regarding ART (45.4% vs 71%) considered it safe to use in stable SLE/APS. Conclusion: The gaps in knowledge identified include the use of hormonal contraception in APS patients and the proper utilization of important medications to prevent and treat lupus flares. Initiation of shared Rheumatology/ obstetric clinics and focusing on the identified educational topics, would lessen the gap in knowledge and discrepancies in practice improve overall patient management.