To Be -- or Not to Be -- Pregnant?
โ This is the question rheumatologists should be asking patients
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A study by Pryor and colleagues in comes to our attention at a perfect time: during a national threat to abortion access. With every passing day, there is more restrictive legislation on reproductive rights.
As rheumatologists, we are no strangers to the consequences of uncontrolled disease activity leading to adverse maternal and fetal outcomes and to concerns about using teratogenic medications in patients of child-bearing age.
The "One Key Question" initiative was originally created by the Oregon Foundation for Reproductive Health in 2013, during a time when contraception access was diminishing in the primary care setting. The goal of this questionnaire was to decrease adverse events for the patient, fetus, and neonate by optimizing health and addressing risk factors. This tool has been implemented in clinics across the country in primary care and obstetrics and gynecology offices.
When this tool was used in the rheumatology setting, it was surprising that it was not implemented as heavily. In their Q&A, study coauthors Candace Feldman and Elizabeth Janiak note that the tool might be utilized more if this question was included in the electronic health record. Although I agree that this may enhance its use, I am also guarded in my optimism because of click fatigue. As these authors note, it is easy to click past notifications -- especially if they are removed at the time of an encounter. Alternatively, would adherence improve if this question were included along with vital signs, PHQ depression screening, and medication reconciliation done by the medical assistants on every patient?
Perhaps the most important point Drs. Feldman and Janiak make is that fewer options are available nationally for those with health- and life-threatening pregnancies. We are on the frontlines of prevention. I am calling on all of my colleagues to make this a priority.
Patil Injean, DO, is a second year rheumatology fellow at Cedars-Sinai Medical Center in Los Angeles.
Read the Q&A with study coauthors here, and the study here.
Primary Source
ACR Open Rheumatology
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