COVID-19 in Pregnant Women With Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance

Bonnie L Bermas; Milena Gianfrancesco; Helen L Tanner; Andrea M Seet; Mathia C Aguiar; Nasra K Al Adhoubi; Samar Al Emadi; Bernardo M Cunha; Rachael Flood; Daria A Kusevich; Eoghan M McCarthy; Naomi J Patel; Eric M Ruderman; Sebastian E Sattui; Savino Sciascia; Faizah Siddique; Maria O Valenzuela-Almada; Leanna M Wise; Angus B Worthing; JoAnn Zell; Suleman Bhana; Wendy Costello; Ali Duarte-Garcia; Rebecca Grainger; Laure Gossec; Jonathan S Hausmann; Kimme Hyrich; Saskia Lawson-Tovey; Jean W Liew; Emily Sirotich; Jeffrey A Sparks; Paul Sufka; Zachary S Wallace; Pedro M Machado; Anja Strangfeld; Megan E B Clowse; Jinoos Yazdany; Philip C Robinson

doi:10.3899/jrheum.210480

COVID-19 in Pregnant Women With Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance

J Rheumatol. 2022 Jan;49(1):110-114. doi: 10.3899/jrheum.210480. Epub 2021 Sep 1.

Authors

Bonnie L Bermas¹, Milena Gianfrancesco², Helen L Tanner³, Andrea M Seet², Mathia C Aguiar⁴, Nasra K Al Adhoubi⁵, Samar Al Emadi⁶, Bernardo M Cunha⁷, Rachael Flood⁸, Daria A Kusevich⁹, Eoghan M McCarthy¹⁰, Naomi J Patel¹¹, Eric M Ruderman¹², Sebastian E Sattui¹³, Savino Sciascia¹⁴, Faizah Siddique¹⁵, Maria O Valenzuela-Almada¹⁶, Leanna M Wise¹⁷, Angus B Worthing¹⁸, JoAnn Zell¹⁹, Suleman Bhana²⁰, Wendy Costello²¹, Ali Duarte-Garcia¹⁶, Rebecca Grainger²², Laure Gossec²³, Jonathan S Hausmann²⁴, Kimme Hyrich²⁵, Saskia Lawson-Tovey²⁶, Jean W Liew²⁷, Emily Sirotich²⁸, Jeffrey A Sparks²⁹, Paul Sufka³⁰, Zachary S Wallace³¹, Pedro M Machado³², Anja Strangfeld³³, Megan E B Clowse³⁴, Jinoos Yazdany², Philip C Robinson³⁵

Affiliations

¹ B.L. Bermas, MD, UTSouthwestern Medical Center, Dallas, Texas, USA.
² M. Gianfrancesco, MPH, PhD, A.M. Seet, MPH, J. Yazdany, MPH, MD, Division of Rheumatology, School of Medicine, University of California, San Francisco, California, USA.
³ H.L. Tanner, MBChB, FRACP, University of Queensland School of Clinical Medicine, Faculty of Medicine, Queensland, Australia.
⁴ M.C. Aguiar, MD, Hospital General Agustin O'Horan, Merida, Mexico.
⁵ N.K. Al Adhoubi, MD, FRCP, Rheumatology Unit, Royal Hospital, Muscat, Oman.
⁶ S. Al Emadi, MBBS, FRCPC, Hamad Medical Corporation, Doha, Qatar.
⁷ B.M. Cunha, MD, PhD, Sarah Network of Rehabilitation Hospitals, Brasília, Brazil.
⁸ R. Flood, MB, BCh, BAO, Tallaght University Hospital, Tallaght, Dublin, Ireland.
⁹ D.A. Kusevich, MD,PhD, V.A. Nasonova Research Institute of Rheumatology, Moscow, and Anikina Clinic, Vidnoe, Russia.
¹⁰ E.M. McCarthy, MB, MRCPI, Manchester University Foundation Trust, Manchester, UK.
¹¹ N.J. Patel, MD, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹² E.M. Ruderman, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
¹³ S.E. Sattui, MD, MS, Hospital for Special Surgery, New York, New York, USA.
¹⁴ S. Sciascia, MD, PhD, Center of Research of Immunopathology and Rare Diseases/Nephrology and Dialysis Unit, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital, Turin, Italy.
¹⁵ F. Siddique, MD, Loyola University Medical Center, Maywood, Illinois, USA.
¹⁶ M.O. Valenzuela-Almada, MBBS, A. Duarte-Garcia, MD, MS, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.
¹⁷ L.M. Wise, MD, University of Southern California, Los Angeles, California, USA.
¹⁸ A.B. Worthing, MD, Arthritis & Rheumatism Associates, PC, and Georgetown University Medical Center, Washington, DC, USA.
¹⁹ J. Zell, MD, University of Colorado, Aurora, Colorado, USA.
²⁰ S. Bhana, MD, Crystal Run Healthcare, Middletown, New York, USA.
²¹ W. Costello, Irish Children's arthritis network (iCan), Tipperary, Ireland.
²² R. Grainger, MBChB, PhD, FRACP, Department of Medicine, University of Otago, Wellington, New Zealand.
²³ L. Gossec, MD, PhD, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Rheumatology Department, Paris, France.
²⁴ J.S. Hausmann, MD, Program in Rheumatology, Division of Immunology, Boston Children's Hospital, and Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
²⁵ K. Hyrich, MD, PhD, FRCPC, Centre for Epidemiology Versus Arthritis, The University of Manchester, and National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
²⁶ S. Lawson-Tovey, BA, National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, and Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK.
²⁷ J.W. Liew, MS, MD, Boston University School of Medicine, Boston, Massachusetts, USA.
²⁸ E. Sirotich, BSc, Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
²⁹ J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
³⁰ P. Sufka, MD, Healthpartners, St. Paul, Minnesota, USA.
³¹ Z.S. Wallace, MD, MSc, Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
³² P.M. Machado, MD, PhD, Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, and National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, and Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK.
³³ A. Strangfeld, MD, Epidemiology Unit, German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany.
³⁴ M.E.B. Clowse, MD, MPH, Duke University School of Medicine, Durham, North Carolina, USA.
³⁵ P.C. Robinson, MBChB, PhD, FRACP, Associate Professor, University of Queensland School of Clinical Medicine, Faculty of Medicine, Queensland, Australia, and Royal Brisbane & Women's Hospital, Metro North Hospital & Health Service, Herston, Queensland, Australia. [email protected].

PMID: 34470798
DOI: 10.3899/jrheum.210480

Abstract

Objective: To describe coronavirus disease 2019 (COVID-19) and pregnancy outcomes in patients with rheumatic disease who were pregnant at the time of infection.

Methods: Since March 2020, the COVID-19 Global Rheumatology Alliance has collected cases of patients with rheumatic disease with COVID-19. We report details of pregnant women at the time of COVID-19 infection, including obstetric details separately ascertained from providers.

Results: We report on 39 patients, including 22 with obstetric detail available. The mean and median age was 33 years, range 24-45 years. Rheumatic disease diagnoses included rheumatoid arthritis (n = 9), systemic lupus erythematosus (n = 9), psoriatic arthritis/other inflammatory arthritides (n = 8), and antiphospholipid syndrome (n = 6). Most had a term birth (16/22), with 3 preterm births, 1 termination, and 1 miscarriage; 1 woman had yet to deliver at the time of report. One-quarter (n = 10/39) of pregnant women were hospitalized following COVID-19 diagnosis. Two of 39 (5%) required supplemental oxygen (both hospitalized); no patients died. The majority did not receive specific medication treatment for their COVID-19 (n = 32/39, 82%), and 7 patients received some combination of antimalarials, colchicine, anti-interleukin 1β, azithromycin, glucocorticoids, and lopinavir/ritonavir.

Conclusion: Women with rheumatic diseases who were pregnant at the time of COVID-19 had favorable outcomes. These data have limitations due to the small size and methodology; however, they provide cautious optimism for pregnancy outcomes for women with rheumatic disease particularly in comparison to the increased risk of poor outcomes that have been reported in other series of pregnant women with COVID-19.

Keywords: COVID-19; anti-TNF; disease-modifying antirheumatic drug; rheumatoid arthritis; rheumatology.

MeSH terms

Adult
COVID-19 Testing
COVID-19*
Female
Humans
Infant, Newborn
Middle Aged
Pregnancy
Pregnant Women
Rheumatic Diseases* / therapy
Rheumatology*
SARS-CoV-2
Young Adult