# Knowledge, Attitude, and Practices of Indian Rheumatologists Regarding Reproductive Rheumatology in Female Patients: A Web-Based Survey

## TL;DR

This study surveys Indian rheumatologists to assess their knowledge, attitudes, and practices in managing reproductive health issues in female patients with rheumatic diseases.

## Contribution

The study identifies knowledge gaps and confidence levels among rheumatologists in reproductive rheumatology, highlighting areas for improvement.

## Key findings

- Most rheumatologists were familiar with guidelines on drug use during pregnancy and breastfeeding.
- Confidence levels were low in discussing oocyte preservation and assisted reproductive techniques.
- Patients often stop medications after confirming pregnancy, leading to poor outcomes.

## Abstract

Managing pregnancy and other reproductive concerns in individuals with rheumatic disease depends on the type of disease, its activity, co-morbidities, and other factors. This study’s primary objective was to evaluate rheumatologists’ knowledge, attitudes, and practices in this field.

This cross-sectional web-based online survey was conducted from October to November 2022 among Indian Rheumatologists. Information was sought regarding knowledge and attitudes in managing pregnancy and reproductive health-related issues, their approach, barriers faced, patient perspectives, and possible solutions.

In total, 122 rheumatologists participated in the survey. Most rheumatologists were familiar with the British Society of Rheumatology (BSR) 2023 and American College of Rheumatology (ACR) 2020 guidelines on prescribing drugs in pregnancy and breastfeeding. Contraception and drug compatibility with breastfeeding were answered appropriately by 80% of the participants. Most (77.9%) were moderately to extremely confident in managing pregnant patients with rheumatic diseases. However, the majority were only slightly or not at all confident in discussing oocyte preservation(63%) and assisted reproductive techniques(65.9%). Almost all reported that their patients had fears about planning a pregnancy due to the disease (92%), and they frequently came across patients prematurely stopping their medicines after pregnancy was confirmed (50.8%).The majority of the respondents (91.7%) felt lack of proper treatment and regular follow-ups were the main contributing factors to poor pregnancy outcomes.

Rheumatologists treating patients with reproductive issues in rheumatic diseases have certain knowledge gaps; filling these gaps can boost their confidence in managing these patients. There is scope for improving collaboration with obstetricians, and patient education.