Adolescent females and young women with sickle cell disease are at risk of pregnancy-related complications, especially considering the teratogenicity of SCD medications. An improvement in contraceptive practices starts with the healthcare provider.
Sickle cell disease (SCD) is an inherited red blood cell defect. Women with SCD face more health risks during pregnancy. Meanwhile, in women with SCD, low rates of contraception use are common, resulting in high rates of unintended pregnancy. Teratogenic SCD medications, especially hydroxyurea, are another safety concern during pregnancy. A study published in Pediatric Blood and Cancer reported data on SCD contraceptive practices among providers.
Based on the Health Belief Model (HBM), researchers devised a 25-question test that can be taken online. Survey links were sent to pediatric SCD and/or general hematology providers all over the country. A total of 160 surveys that met the inclusion criteria were analyzed.
Most providers said that they talked to women of childbearing age with SCD (77.5%) and referred them for contraception (90.8%). However, only 41.8% of providers reported prescribing contraception. In terms of contraceptive methods, barrier methods (i.e., condoms) were most commonly recommended (82.8%). Over 50% reported counseling on pills, patches, rings, injections, implants, and intrauterine devices. The contraceptive injection (26.5%) was the most commonly prescribed method.
Contraceptive counseling did not differ based on the gender or age of the provider. In contrast, fewer trainees provided counseling or prescriptions when compared to established providers. Prescriptions did not differ significantly based on provider beliefs about hydroxyurea’s potential teratogenicity. In addition, patient requests and sexual activity disclosure were important motivators for prescription practices. Inadequate provider training, limited visit time, and perceived patient/parent interest proved to be major barriers for appropriate contraceptive practices.
According to the author, clinical guidelines, training protocols, and patient/parent decision-making tools could be evaluated in the future to improve contraceptive practices in SCD.
Source:
Askew, M. A., Smaldone, A. M., Gold, M. A., Smith-Whitley, K., Strouse, J. J., Jin, Z., & Green, N. S. (2022). Pediatric hematology providers’ contraceptive practices for female adolescents and young adults with sickle cell disease: A national survey. Pediatric Blood & Cancer, 69(10), e29877. https://doi.org/10.1002/pbc.29877
