Identifying the Unmet Reproductive Health Needs for Women with Rheumatic Diseases in Kuwait: A Commentary

Women of childbearing age diagnosed with RDs, such as rheumatoid arthritis and systemic lupus erythematosus, encounter distinct challenges that impact their reproductive health [1-4]. These chronic health conditions often raise concerns regarding family planning and medication safety during pregnancy and breastfeeding [5]. Managing reproductive health in patients with RDs presents unique challenges and requires a coordinated, multidisciplinary approach involving rheumatologists, obstetricians, gynecologists, maternal-fetal medicine specialists, and obstetric medicine physicians to ensure comprehensive care [6-8]. 

Recent advances in reproductive health and pregnancy care offered new hope and improved outcomes for patients living with RDs, provided their rheumatic condition management is optimized [6]. The current study, with its diverse cohort of 150 women with RDs from Kuwait, sheds light on the specific areas where reproductive health counseling could be enhanced. These findings help us better understand women's experiences in Kuwait, where cultural values, personal concerns, and clinical practices often shape reproductive health discussions differently than in other parts of the world.

The researchers employed an anonymized electronic survey to better understand the specific reproductive health needs and experiences of women with RDs in Kuwait. This format likely encouraged open and honest responses, especially given the sensitivity of the topic. However, it can also introduce a few limitations typical of self-reported data, such as recall bias and incomplete capture of nuanced experiences. The study focused on women aged 21-49 years.

One of the most striking findings in this study was that just 26% of women with RDs received any guidance on contraception, even if they were on teratogenic medications. This gap raises concerns, especially when compared to international recommendations from multiple organizations such as the American College of Rheumatology (ACR), European Alliance of Associations for Rheumatology (EULAR) and the British Society of Rheumatology (BSR), which emphasize the importance of communication between patients and their rheumatologists [9-11]. On the other hand, 63.3% of women received counseling regarding the importance of disease control before pregnancy, which is two times higher than the rate reported in some United States-based studies, where only one-third of women had similar discussions with their rheumatologists [12]. Nevertheless, this percentage still reflects a significant gap. While many participants expressed a keen interest in having future pregnancies, they felt that their counseling was insufficient. This can be mitigated by creating a healthcare environment where discussions about family planning are not just accepted but actively promoted and encouraged. 

Furthermore, the majority of women were willing to continue their medication during pregnancy (64.7 %) and breastfeeding (57.3 %), if deemed safe. However, concerns regarding potential adverse effects on the fetus persisted. Addressing these fears through clear and empathetic communication can empower women to make informed decisions about their reproductive health. 

Additionally, 57.5% of patients were counseled regarding the need for regular antenatal follow-up once pregnancy is confirmed, further emphasizing the importance of comprehensive care throughout pregnancy.

This study examines the existing literature that shows the need to enhance reproductive health support for women with rheumatic conditions. Several publications demonstrated how addressing reproductive concerns are frequently missed in routine care, even though they play a vital role in women’s overall health and life planning [5]. In addition, the authors pointed out the call for a more multidisciplinary approach to reproductive care, especially for women with RDs that could affect pregnancy outcomes [6-8]. They also highlight regional challenges, including a shortage of local guidelines and limited awareness among healthcare providers about reproductive counseling in chronic illness care [7]. These findings add strength to the argument that culturally tailored solutions are needed in Kuwait and neighboring countries that share similar cultural values and backgrounds. 

While the study is limited by its small sample size and is specific to a single country, making it difficult to generalize the findings, comparisons with international data suggest that what women with RDs in Kuwait are experiencing is part of a broader global issue and is prevalent across different healthcare systems. The authors feel strongly that reproductive health issues should no longer be seen as optional or secondary in the care of women with RDs, but instead, they should be a key part of routine care that focuses on the patient as a whole. Additionally, they call for the establishment of specific local and regional policies for medication management and preconception counseling to ensure standardized care for this vulnerable group of patients.

This study enhances our understanding of the reproductive health needs, shortcomings and gaps of women with RDs in Kuwait. It underscores the importance of incorporating comprehensive counseling into routine healthcare, particularly in the rheumatology setting. By identifying existing gaps, the study opens the door for further research and encourages healthcare providers to engage with their patients in meaningful conversations about family planning and reproductive choices. 

Moving forward, it is essential for both healthcare professionals and healthcare systems to prioritize reproductive health counseling for women with RDs. Collaborative initiatives between rheumatologists and obstetric specialists will be crucial for shaping policies that promote informed decision-making and enhance support for this vulnerable population.

The authors declare no conflict of interest.

The authors equally contributed to the preparation and writing of the commentary. All authors approved the submitted version.

Not needed.

No Funding.

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