COVID-19 prompts prenatal care changes in 67% of pregnant patients with rheumatic disease
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Patients at a major New York rheumatology center who were pregnant reported similar COVID-19 prevalence and disease severity as those who were not pregnant, while 67% reported changes to their prenatal care, according to data.
“Within the United States, New York City was an early ‘hot spot’ from March through May 2020,” Medha Barbhaiya, MD, MPH, of the Hospital for Special Surgery and Weill Cornell Medicine, and colleagues wrote in Arthritis Care and Research. “Pregnant women experience immunologic and physiologic changes shown to increase the risk for more severe illness from infections. In addition, patients with rheumatic diseases may be at increased risk of severe illness due to immune dysfunction and use of immunomodulatory or immunosuppressive medications.”
“It is not known if pregnant rheumatic disease patients have greater SARS-CoV-2 associated risks,” they added. “In previous coronavirus outbreaks (the severe acute respiratory syndrome coronavirus [SARS-CoV] and the Middle East respiratory syndrome coronavirus) and the H1N1 influenza outbreak, pregnant women were at increased risk for endotracheal intubation, intensive care unit (ICU) admission, renal failure and death.”
To analyze the experiences of patients with rheumatic disease who were pregnant during the COVID-19 pandemic in New York City, Barbhaiya conducted a survey at the Hospital for Special Surgery. The researchers forwarded the web-based survey to all English-speaking adult patients who had at least one rheumatology visit at the center between April 1, 2018, and April 21, 2020, and an email address. Prospective participants received up to three survey invitations between April 24 and May 17, while a subset with missing or incorrect email addresses were contacted via phone.
As part of the survey, women aged 18-50 years were asked to indicate pregnancy status on Jan. 1 and at survey completion. Other questions explored the pandemic’s impact on prenatal care and perinatal outcomes. Women who answered the pregnancy questions within the general medical history questionnaire were also included in the analysis. The researchers ended data collection July 1, 2020, with a total of 7,094 respondents. Among these patients, 1,547 were women aged 18-50 years, of whom 61 — or 4% — reported they were pregnant during the COVID-19 pandemic.
According to the researchers, the prevalence of self‐reported COVID‐19 was similar among pregnant and non‐pregnant respondents, at 8% and 9%, respectively (P = .76). Among patients with COVID‐19, those who were pregnant demonstrated shorter symptom duration (P < .01), and were more likely to experience loss of smell or taste (P = .02), than those who were not pregnant. Approximately three‐fourths of women had a systemic rheumatic disease, with no reported differences when stratified by pregnancy or COVID‐19 status.
In addition, 67% of patients who were pregnant reported changes to prenatal care during the pandemic, and 23% of postpartum individuals said the pandemic affected their delivery.
“The COVID-19 pandemic offers a rare opportunity to study the impact of a serious infection on pregnant patients with rheumatic disease, which only few studies have previously addressed,” Barbhaiya and colleagues wrote. “Our finding of similar COVID-19 prevalence and disease severity in pregnant versus non-pregnant patients must be interpreted with caution, but provides helpful data to women with systemic rheumatic diseases contemplating pregnancy during the pandemic.”
“The shortened overall symptom duration and universal loss of smell or taste in pregnant women with COVID-19 also provides preliminary information to guide clinicians taking care of pregnant patients during the pandemic,” they added. “As universal COVID-19 testing for pregnant patients admitted for delivery is increasingly performed, future studies may better assess the impact of the pandemic on perinatal and postpartum outcomes in this unique population.”
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