Suboptimal contraceptive counseling and use in women with autoimmune rheumatic diseases of childbearing age: findings from a cross-sectional survey of patients.

Women with autoimmune rheumatic diseases (ARDs) require effective contraception to prevent unplanned pregnancies and minimize risks associated with disease activity and teratogenic medications. Despite established guidelines, contraception counseling and use remain suboptimal. This study aimed to assess contraception use and patient preferences for reproductive health counseling in a cohort of women with ARDs. We conducted a cross-sectional survey between January 2023 and February 2024 at a tertiary rheumatology center in Italy. Consecutive women aged 18-50 years with a confirmed autoimmune rheumatic disease (ARD) diagnosis were invited to complete a 47-item anonymous questionnaire covering sexuality, contraception, fertility, pregnancy, breastfeeding, medication safety, and disease transmissibility. Descriptive statistics and subgroup comparisons were performed using chi-square, Fisher's exact test, and Mann-Whitney U test, with significance set at p < 0.05. A total of 189 women participated, of whom 156 were premenopausal (mean age 31 years, mean disease duration 7 years). Among them, 37.8% (n = 59) reported not using any contraception, 40.4% (n = 63) used barrier methods, and 23.1% (n = 36) relied on effective or highly effective methods, including only 5.8% (n = 9) using long-acting reversible contraceptives. Alarmingly, 71.0% of women treated with teratogenic drugs were not using contraception. While 64.7% (n = 101) had discussed contraception with their partner, only 13.5% (n = 21) had spoken with a healthcare provider, and merely 6.3% (n = 2) of those on teratogenic medications expressed interest in dedicated counseling. Our findings highlight significant gaps in contraception counseling and adherence among women with ARDs, particularly those at high risk for medication-related fetal harm. Given the potential impact on maternal-fetal health, rheumatologists should routinely integrate reproductive health discussions into patient care and collaborate with gynecologists to improve contraception uptake. Targeted educational programs may enhance awareness and adherence to contraception guidelines, ultimately optimizing pregnancy outcomes in women with ARDs.