Rheumatology Fellow’s Current Research Offers Improved Guidance to Women with Vasculitis in all Areas of Reproduction

For women of reproductive age, having a family is a natural inclination, and one that brings great joy to them and their families. While complications can occur during pregnancy in women with vasculitis, there is little comprehensive, prospective data on the topic. Fortunately, current research offers improved guidance to these women in all areas of reproduction—from birth control and assisted reproductive technology to pregnancy and lactation—so that having a family can be done as safely as possible for mother and baby.

Catherine Sims, MD, is a second-year fellow at Duke University’s School of Medicine, Division of Rheumatology. Dr. Sims earned her medical degree from Virginia Tech Carilion School of Medicine, completed her residency at The Ohio State University, and began her three-year fellowship at Duke in July 2020. Her main research project is expanding the vasculitis in pregnancy (V-PREG) database and evaluating pregnancy outcome data. “The V-PREG database was created to enrich our understanding of this population with the hope of offering improved medical management and prognostication,” Dr. Sims explained.

Through the extensive efforts of Megan Clowse, MD, Peter Merkel, MD, MPH, and the Vasculitis Foundation (VF), the V-PREG database is now international and continues to recruit women all over the world. “This year, I will be utilizing funding from a Union Chimique Belge (UCB) Women’s Health Fellowship grant to perform a qualitative analysis of pregnancy outcomes from the first five years of V-PREG,” Dr. Sims said. This includes contacting women and asking open-ended questions regarding their experiences with pregnancy, breastfeeding, and reproductive health as a patient with vasculitis. “We want to give these women a voice as their perceptions of reproduction with vasculitis are crucial to understanding how medical professionals can better support them,” Dr. Sims noted.

Dr. Clowse became Dr. Sims’ mentor within a few months of her starting the fellowship at Duke. “From the beginning, she has placed full trust in me to accomplish meaningful tasks and I’m thankful for the confidence she has in my abilities,” Dr. Sims said. “Both her and Dr. Merkel created V-PREG before I started fellowship and I’m grateful for their efforts in this area and their willingness to add me to the team.” Dr. Sims hopes to become a well-rounded rheumatology fellow with extensive training and exposure to vasculitis and reproductive health in autoimmune disease.

In a year-long effort in collaboration with the VF, Dr. Sims and Dr. Clowse developed a two-page handout to help patients and rheumatologists facilitate a meaningful and thorough discussion about safe pregnancy and birth control. “Current research shows rheumatologists are uncomfortable discussing birth control and pregnancy with their patients of reproductive age,” Dr. Sims said. “This is unfortunate as most women want their rheumatologist to initiate these conversations. Some of our medications are teratogenic [related to or cause developmental defects] so it is our responsibility to assess family planning goals on a regular basis to ensure medical decisions are in line with a patient’s personal plans,” she said.

The handout was created as a tool for physicians and patients to streamline this discussion and ensure a comprehensive approach. It walks through all areas of rheumatologic care that need to be addressed in a patient considering pregnancy. If pregnancy is not in the patient’s plan for the upcoming year, then a safe and effective birth control strategy should be confirmed. “Our hope is this will improve the confidence of providers to approach this topic and empower patients to make educated decisions regarding their fertility,” Dr. Sims said.

It’s important to note that reproductive decisions are not limited to female patients. “Our handout also addresses male vasculitis patients considering pregnancy with their partners,” Dr. Sims added. “Our next step is to create videos with the VF, walking through the handout and answering frequently asked questions with vasculitis patient representatives. These will be short videos that can be easily accessed by patients and physicians on the VF website.”

Dr. Clowse and Dr. Sims are also working on pregnancy outcome data in systemic lupus erythematosus (SLE) patients with a specific focus on pregnancy planning in Black women. “Black women are subject to systemic biases and racism in medicine and face additional obstacles with SLE,” Dr. Sims said. “We are assessing our SLE providers’ ability to gauge pregnancy interest and offer pregnancy planning to these women for minimization of poor pregnancy outcomes.”

Dr. Sims plans to continue her research-focused academic career with a special interest in vasculitis and reproductive health.

Click the link to access the Vasculitis Family Planning Birth Control Handout.

For more information, visit the V-PREG website.