TOP 9 - Baseline Assessment of Reproductive Health Screening in the Clinical Setting Among Pediatric Patients with Rheumatic Disease on Disease Modifying Anti-Rheumatic Drugs in a Single Center

Publication Number: 2836.TOP 9

Vahnee Garimella, Stony Brook Children's Hospital, PORT JEFFERSON, NY, United States; Yasaman Badakhshi, Stony Brook University - - Stony Brook, NY, Port Jefferson, NY, United States; Julie Cherian, Stony Brook Children's Hospital, Stony Brook, NY, United States; Farzana Nuruzzaman, Stony Brook Children's Hospital, Stony Brook, NY, United States

Background: Disease modifying anti-rheumatic drugs (DMARDs) are the mainstay treatment for multiple rheumatic diseases (RMD). Currently, while the American College of Rheumatology has published the risk of teratogenicity for female adults with RMD, there is no formal screening process for at risk individuals among the pediatric population despite the risk of poor reproductive health outcomes due to disease-related risks and teratogen use in this population (1). With ongoing discussions regarding internal bias and the role in medicine, there can often be unlabeled barriers to adequate screening in the clinical setting, as well. Therefore, it is essential to perform a comparison of several risk factors to identify associations with teratogenicity, especially in correlation with demographic markers of the patient population within the single center.

Objective: We aimed to 1) determine rates of risk screening, including screening for menarche, last menstrual period, and sexual activity per patient encounter and 2) identify potential associations of rate of risk screening with demographic characteristics, such as self-identified race, primary language, religion and current DMARD use.

Design/Methods: A retrospective chart review was conducted on patients in Stony Brook Children's Hospital pediatric rheumatology clinic between August 2016 to December 2023. The following inclusion criteria was utilized: patient aged ≥10 years or older assigned female at birth or have achieved menarche, diagnosed with RMD at age less than 18 years and on a potentially teratogenic DMARD (methotrexate, mycophenolate/ and mycophenolic acid, leflunomide, cyclophosphamide, thalidomide). We documented factors including documentation of/incidence of menarche, last menstrual period, sexual activity screening and current DMARD use. Data regarding demographic features, such as self-identified race, religion, and primary language, were also collected. For this study, 42 patients, with 670 total visit encounters, were selected and analyzed using the inclusion criteria above. Descriptive statistical value and differences in rates of risk stratification screening (including sexual activity and menarche screening) in correlation with demographics characteristics or disease activity will be evaluated using Chi-square test for significance.

Al-Husayni, N., Maslyanskaya, S., Rubinstein, T. B., & Coupey, S. M. (2023). Reproductive Health Care for Female Adolescents Prescribed Mycophenolate at a Children's Hospital: A 10-Year Retrospective Cohort Study. The Journal of pediatrics, 253, 252-258. https://doi.org/10.1016/j.jpeds.2022.09.052

Demographics and Clinical Features Table
The above table is for all included patients' demographics and clinical features. The total N is 42 patients with individual demographics as well as clinical features (race, primary language, religion, insurance, diagnosis, menarache, prior parity, and HPV vaccination status).