P3.022: Missed Opportunities for Reproductive Health Counseling in Adolescents with Chronic Medical Conditions

Background: Adolescents and young adults (AYAs) with chronic medical conditions (CMC) have rates of sexual activity similar to their healthy peers, but much lower rates of contraceptive use, despite their increased risk of morbidity and mortality from unintended pregnancy. Contributing factors may include limited education about pregnancy-related risks and lack of access to reproductive health counseling through their subspecialty providers. The objective of this study is to evaluate contraception knowledge, access, and experiences with reproductive health counseling among AYAs with CMC.

Methods: In this cross-sectional survey study, pregnancy-capable AYAs aged 12-24 years with CMC were recruited from pediatric subspecialty clinics (cardiology, pulmonology, diabetes, organ transplant, rheumatology, hematology, oncology, and neurology) if they had a diagnosed medical condition that “poses a significant pregnancy health risk or requires the use of teratogenic drugs” as defined by the World Health Organization. The survey assessed their experiences of and preferences for reproductive health counseling in their subspecialty practices.

Results: 322 AYAs with CMC were recruited. The median age was 16 (range 12-24 years). 69% of participants self-reported their disease severity as “moderate or severe.” 33% of participants reported prior sexual activity. Participants overwhelmingly reported that their subspecialty providers’ advice was “somewhat or very important” in their birth control decisions (88.2%). Although most patients feel comfortable talking to their subspecialty providers about sex (59.3%) or birth control (76.3%), only 48.9% of patients reported that their subspecialty providers had asked them questions confidentially about their sexual history or birth control options. Few participants reported that their subspecialty providers had discussed possible risks of pregnancy with their medical condition (16.1%), advised them to use birth control to avoid unintended pregnancy with their medical condition (6.8%) or told them that their medications could cause complications in pregnancy (20.8%).

Conclusion: Although AYAs with CMC value their subspecialty providers’ counsel on their reproductive health and are often at high risk of complications in pregnancy, pediatric subspecialty providers rarely discuss the risks of unintended pregnancy or counsel on contraception. Incorporating reproductive health in pediatric subspecialty care is an essential component of comprehensive care for AYA with chronic medical conditions.