Are pregnant women with rheumatic disease at risk of poor COVID-19 outcomes?

Pregnant women with rheumatic disease and COVID-19 show favourable outcomes, but data are limited by the small sample size and methodology, reports a study.

Additionally, “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,” the researchers said.

The COVID-19 Global Rheumatology Alliance (C19-GRA) collected cases of patients with rheumatic disease and COVID-19 since March 2020. The researchers then reported details of pregnant women at the time of SARS-CoV-2 infection, including obstetric details separately determined from providers.

Thirty-nine patients (mean age 33 years, range 24‒35) were included, of whom 22 had obstetric detail available. Rheumatic diseases diagnosed were rheumatoid arthritis (n=9), systemic lupus erythematosus (n=9), psoriatic arthritis/other inflammatory arthritides (n=8), and antiphospholipid syndrome (n=6). [J Rheumatol 2022;49:110-114]

Majority of the pregnant women had term birth (16/22), with three preterm births, one termination, and one miscarriage; one woman had yet to deliver at the time of report. Ten of the 39 participants were hospitalized after being diagnosed with COVID-19, with two patients (5 percent) requiring supplemental oxygen. None of them died.

Thirty-two patients (82 percent) did not receive specific medication treatment for COVID-19, while seven were treated with some combination of antimalarials, colchicine, anti-interleukin 1β, azithromycin, glucocorticoids, and lopinavir/ritonavir.

“In our small patient series, the coexistence of a systemic rheumatic disease and pregnancy did not portend worse outcomes from COVID-19 infection than what has been observed in the general population of pregnant women,” the researchers said.

The C19-GRA previously reported the association of poorer outcomes with older age, comorbidities, higher doses of prednisone, high disease activity, and some specific medications among individuals with rheumatic conditions. [Ann Rheum Dis 2020;79:859-866]

Based on recent data from the Centers for Disease Control, pregnant women with COVID-19 infection have higher odds of hospitalization, requiring mechanical ventilation, and even death compared to nonpregnant women. [MMWR Morb Mortal Wkly Rep 2020;69:1641-1647]

Likewise, a UK study involving 427 hospitalized pregnant women reported 10 percent of patients requiring mechanical ventilation, with 1 percent mortality. Of note, half of these patients were from racial and ethnic minorities. [BMJ 2020;369:m2107]

In the US, ethnic minorities in nonpregnant patients from the GRA registry were more likely to have poor outcomes. In addition, the presence of rheumatic disease and its medications could influence outcomes in pregnant women. [Arthritis Rheumatol 2021;73:374-380]

“Additional cases with greater granularity of data regarding pregnancy and foetal outcomes in the rheumatic disease population will greatly enhance our knowledge in this area,” the researchers said.

The current study is limited by its small sample size and incomplete data on obstetric outcomes. Selection bias in reported cases is also possible since the C19-GRA registry data are voluntarily submitted: more complex rheumatic diseases and active disease are being reported, and more severe COVID-19 cases are more likely to be included in the registry.

“In addition, our patients were young, had few comorbidities, and were on low GC doses, all of which may have contributed to a more benign course,” the researchers said. “Finally, these findings are purely descriptive.”