ABSTRACT
Pregnancy is a major cause of morbidity and mortality among women with rheumatic diseases and their children;
thus, one of the most important decisions that a woman with a rheumatic disease may make is if and/or when
she wishes to conceive. However, my foundational work has found that many of these women are unable to make
informed decisions around pregnancy because their information needs are unmet. To meet this immediate and
urgent patient need, I will develop a novel, patient-facing decision aid called MyVoice to help women to make
informed pregnancy decisions and augment family planning care receipt in the rheumatology clinical setting
(Aim 1). I will pilot MyVoice in rheumatology clinics to assess its feasibility, acceptability, and implementation
potential (Aim 2). This work will serve as the foundation for a future hybrid implementation-effectiveness trial
to evaluate if MyVoice increases women’s disease-specific reproductive knowledge and family planning care
receipt, and ultimately improves their downstream reproductive outcomes.
One of the major predictors of adverse pregnancy and perinatal outcomes among women with rheumatic diseases
is active disease at the time of conception and during pregnancy. My prior work suggests that some women may
experience active disease during pregnancy because they decide not to adhere to pregnancy-compatible anti-
rheumatic drugs; they fear that their medications might adversely affect fetal development. In Aim 3, I will
develop a longitudinal, exploratory cohort of young women with rheumatic diseases to evaluate how medication
adherence is influenced by key time-varying and time-invariant upstream risk factors (i.e., pregnancy intentions,
reproductive knowledge, symptom severity, family planning care receipt). In a subsequent R01 study, I will
assess how these upstream factors lead to healthy or adverse reproductive outcomes-- thus, positioning me to
identify novel targets for interventions that may enhance reproductive outcomes. I will maintain and expand this
cohort over my career to serve as a source of additional hypotheses and scientific inquiry.
Eighty percent of patients with rheumatic diseases are women, many of whom are reproductive-age when they
are diagnosed; thus, my Aims are highly clinically relevant to rheumatology patients and practitioners. This K23
project will generate new knowledge that may be used to enhance the reproductive outcomes of a vulnerable
group of women and their children. These Aims will also help me to meet my career objectives through
development of a skill set that includes patient-centered intervention development, conduct of clinical trials,
practical implementation, cohort creation, and advanced growth curve modeling to evaluate time-varying risk
factors in my proposed cohort. My project provides preliminary data for two distinct but complementary paths
to R01 funding. My outstanding mentorship team will support the successful completion of my Aims and career
development milestones, to facilitate my transition to an independent outcomes researcher in rheumatology.