Unvaccinated pregnant patients with RMDs, COVID-19 at higher risk for preterm birth
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PHILADELPHIA — Preterm birth is more frequent among unvaccinated pregnant patients with rheumatic and musculoskeletal diseases and COVID-19 vs. fully vaccinated patients, according to findings presented at ACR Convergence 2022.
“In the general population, we know that COVID-19 vaccination has been associated with more mild clinical symptoms, lower need for hospitalizations and even a decreased mortality in patients who have a subsequent COVID-19 infection,” Sinead Maguire, MB, BCh, BAO, MRCPI, a rheumatology fellow at Toronto Western Hospital, told attendees. “For pregnant women, this is important because more mild symptoms of COVID-19 have been associated with a lower risk of adverse pregnancy outcomes compared to women with more severe COVID-19 related illness.
“Unfortunately, there is really limited data on this area in the post COVID-19 vaccination era for women with rheumatic and musculoskeletal diseases,” she added.
To determine obstetric outcomes based on COVID-19 vaccination status among women with rheumatic and musculoskeletal diseases who developed a COVID-19 infection, Maguire and colleagues extracted data on pregnant women who were entered into the COVID-19 Global Rheumatology Alliance (GRA) registry between March 24, 2020, and February 25, 2022.
The researchers collected supplemental data, specifically on obstetric outcomes, via electronic surveys to all health care professionals who previously submitted data on pregnant patients into the GRA. Maguire and colleagues then stratified obstetric outcomes by the number of COVID-19 vaccine doses received prior to COVID-19 infection in pregnancy. They defined partially or unvaccinated as zero to one dose of the COVID-19 vaccine, while fully vaccinated was defined as two or more doses; they noted that none of the patients reported receiving the single dose Johnson & Johnson vaccine.
“This population was really interesting because it represented a wide array not only of ethnicities, but also rheumatic and musculoskeletal diseases, with lupus and rheumatoid arthritis being the most common,” Maguire said.
According to study results, COVID-19 precipitated delivery in 6.8% (n = 3) of unvaccinated patients and only 3.8% (n = 1) of fully vaccinated patients. Among completed pregnancies, the researchers observed a greater number of preterm births in unvaccinated women compared to fully vaccinated women — 29.5% vs. 18.2%, respectively.
At the time of COVID-19 diagnosis, 60.3% (n = 44) of women were unvaccinated, 4.1% (n = 3) had received one dose and 35.6% (n = 26) had received two or more doses. Although 20.5% (n = 15) of patients required hospital admission, only 16.4% (n = 12) of patients required COVID-19 specific pharmacological therapy.
The most frequent neonatal complication was low birthweight, recorded in 24% of pregnancies that resulted in live births, followed by small for gestational age, which was observed in 14% of pregnancies.
“The biggest findings to come out of this study were that unvaccinated pregnant women with rheumatic and musculoskeletal diseases, and concurrent COVID 19 infection, were observed to have a higher frequency of preterm birth vs. those who are fully vaccinated,” Maguire said. “We also noticed that, although hospitalization was common regardless of the vaccination status, the majority of patients did not require treatment for their COVID-19. These results support active promotion of COVID-19 vaccination in women with rheumatic and musculoskeletal-related diseases for either pregnant or planning a pregnancy.”
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Maguire S. Abstract 950. Presented at: ACR Convergence 2022; Nov. 11-14, 2022; Philadelphia (hybrid meeting).
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