Pregnant women with rheumatic disease 'appeared to cope OK' with COVID-19 in small sample
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Patients with rheumatic diseases who were pregnant at the time of developing COVID-19 demonstrated favorable pregnancy and infection outcomes, according to data published in The Journal of Rheumatology.
“There are limited data to inform COVID-19 prognosis and pregnancy outcomes in women who are pregnant and infected with SARS-CoV-2,” Philip C. Robinson, MBChB, PhD, FRACP, of the University of Queensland School of Clinical Medicine, in Herston, Australia, and colleagues wrote. “Data reported in November 2020 included 23,434 pregnant women with COVID-19 and found they were significantly more likely than non-pregnant women to be admitted to an intensive care unit (ICU), receive invasive ventilation, receive extracorporeal membrane oxygenation and die.”
“However, none of these reports specifically included women with autoimmune or rheumatologic disorders or those taking immunosuppressive therapy,” they added. “Among non-pregnant patients with rheumatic disease and COVID-19, initial reports from the COVID-19 Global Rheumatology Alliance physician registry of patients suggested that patients generally fared well. Some medications were associated with poorer outcomes. A large comparative study suggested that poorer outcomes in patients with rheumatic disease were likely mediated by comorbidities.”
To examine COVID-19 and pregnancy outcomes in patients with rheumatic disease who were pregnant at the time of coronavirus infection, Robinson and dozens of colleagues across 13 nations analyzed data from the COVID-19 Global Rheumatology Alliance (GRA). For this study, the researchers focused on pregnant patients whose physicians entered them into the GRA registry between March 24, 2020, and Jan. 14, 2021.
The researchers sent follow-up surveys to providers who had indicated their patient was pregnant in the registry. Five patients diagnosed based solely on symptoms, including three with additional pregnancy data, were excluded. Data on whether drugs were ceased or continued through COVID-19 illness were also reported if provided in the registry. The researchers also analyzed outcomes among non-pregnant patients aged 20 to 45 years old from the GRA registry.
In all, the study included 39 pregnant patients — among whom 22 had obstetric data available — with rheumatoid arthritis, systemic lupus erythematosus, psoriatic or other inflammatory arthritides, or antiphospholipid syndrome. The age range of the included patients was 24 to 45 years.
According to the researchers, among the included patients with available obstetric data, 16 experienced term birth. Among the remaining, there were three pre-term births, one termination, one miscarriage and one patient who had yet to deliver at the time of the researchers’ report. Among the 39 included pregnant patients, 10 were hospitalized following COVID-19 diagnosis, and two required supplemental oxygen. No patients died.
In addition, 32 out of the 39 did not receive any specific medication treatment for COVID-19. The remaining seven patients received a combination of antimalarials, colchicine, anti-IL-1-beta, azithromycin, glucocorticoids and lopinavir/ritonavir.
“The clinical significance of our findings is limited by our sample size, but it is reassuring in that most patients in this small series appeared to cope OK with COVID-19,” Robinson told Healio Rheumatology. “We certainly need to keep a close eye on these patients because experience says they can deteriorate quickly, as can any COVID-19 patient.”
Perspective
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Based on this small data set, which is biased by the fact that the rheumatologists were part of the COVID-19 Global Rheumatology Alliance, pregnant women with autoimmune diseases did not have poor obstetrical outcomes and did not require mechanical ventilation or other heroic measures to survive their COVID-19 infection. Given this information, rheumatologists should be able to be cautiously optimistic with regards to pregnancy outcomes in their patients with rheumatic diseases, but larger data sets would certainly be more reassuring if the outcomes are similar.
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