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Maguire S, Al-Emadi S, Alba P, Aguiar MC, Lawati TA, Alle G, Bermas B, Bhana S, Branimir A, Bulina I, Clowse M, Cogo K, Colunga I, Cook C, Cortez KJ, Dao K, Gianfrancesco M, Gore-Massey M, Gossec L, Grainger R, Hausman J, Hsu TYT, Hyrich K, Isnardi C, Kawano Y, Kilding R, Kusevich DA, Lawson-Tovey S, Liew J, McCarthy E, Montgumery A, Moyano S, Nasir N, Padjen I, Papagoras C, Patel NJ, Pera M, Pisoni C, Pons-Estel G, Quiambao AL, Quintana R, Ruderman E, Sattui S, Savio V, Sciascia S, Sencarova M, Morales RS, Siddique F, Sirotich E, Sparks J, Strangfeld A, Sufka P, Tanner H, Tissera Y, Wallace Z, Werner ML, Wise L, Worthing AB, Zell J, Zepa J, Machado PM, Yazdany J, Robinson P, Conway R. Obstetric Outcomes in Women with Rheumatic Disease and COVID-19 in the Context of Vaccination Status. Rheumatology (Oxford) 2022; 62:1621-1626. [PMID: 36124987 DOI: 10.1093/rheumatology/keac534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe obstetric outcomes based on COVID-19 vaccination status, in women with rheumatic and musculoskeletal diseases (RMDs) who developed COVID-19 during pregnancy. METHODS Data regarding pregnant women entered into the COVID-19 Global Rheumatology Alliance registry from 24 March 2020-25 February 2022 were analysed. Obstetric outcomes were stratified by number of COVID-19 vaccine doses received prior to COVID-19 infection in pregnancy. Descriptive differences between groups were tested using the chi -square or Fisher's exact test. RESULTS There were 73 pregnancies in 73 women with RMD and COVID-19. Overall, 24.7% (18) of pregnancies were ongoing, while of the 55 completed pregnancies 90.9% (50) of pregnancies resulted in livebirths. At the time of COVID-19 diagnosis, 60.3% (n = 44) of women were unvaccinated, 4.1% (n = 3) had received one vaccine dose while 35.6% (n = 26) had two or more doses. Although 83.6% (n = 61) of women required no treatment for COVID-19, 20.5% (n = 15) required hospital admission. COVID-19 resulted in delivery in 6.8% (n = 3) of unvaccinated women and 3.8% (n = 1) of fully vaccinated women. There was a greater number of preterm births (PTB) in unvaccinated women compared with fully vaccinated 29.5% (n = 13) vs 18.2%(n = 2). CONCLUSION In this descriptive study, unvaccinated pregnant women with RMD and COVID-19 had a greater number of PTB compared with those fully vaccinated against COVID-19. Additionally, the need for COVID-19 pharmacological treatment was uncommon in pregnant women with RMD regardless of vaccination status. These results support active promotion of COVID-19 vaccination in women with RMD who are pregnant or planning a pregnancy.
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Affiliation(s)
- Sinead Maguire
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
| | - Samar Al-Emadi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Paula Alba
- Hospital Cordoba, Rheumatology Unit, Cordoba, Argentina.,Universidad Nacional de Cordoba, School of Medicine, Cordoba, Argentina
| | | | - Talal Al Lawati
- Department of Rheumatology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Gelsomina Alle
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Suleman Bhana
- Department of Rheumatology, Crystal Run Healthcare, Middleton, New York, USA
| | - Anic Branimir
- School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, Division of Immunology and Rheumatology, Department of Internal Medicine, Zagreb, Croatia
| | - Inita Bulina
- Department of Rheumatology, Paul Stradins Clinical University Hospital, Riga, Latvia.,Department of Internal Diseases, Riga Stradins University, Riga, Latvia
| | - Megan Clowse
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Karina Cogo
- Department of Rheumatology, Hospital Interzonal Luis Guemes, Buenos Aires, Argentina.,Hospital San Juan De Dios, Department of Rheumatology, Buenos Aires, Argentina
| | - Iris Colunga
- Hospital Universitario Dr Jose Eleuterio Gonzalez, Department of Rheumatology, Monterrey, Mexico
| | - Claire Cook
- Division of Rheumatology, Massachusetts General Hospital, Allergy & Immunology, Boston, Massachusetts, USA
| | - Karen J Cortez
- Baguio General Hospital and Medical Center, Department of Rheumatology, Baguio City, Philippines
| | - Kathryn Dao
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Milena Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Laure Gossec
- Sorbonne Universite, Paris, France.,Pitie-Salpetriere Hospital, Paris, France
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jonathon Hausman
- Department of Pediatric Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Rheumatology and Clinical Immunology, Beth Isreal Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tiffany Y T Hsu
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kimme Hyrich
- The University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, UK.,Department of MSK Research, Manchester Academic Health Science Centre, Manchester, UK.,Department of Biomedical Research, UK and National Institute of Health Research Manchester, Manchester, UK
| | - Carolina Isnardi
- Argenitine Society of Rheumatology, Research Unit, Buenos Aires, Argentina
| | - Yumeko Kawano
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA
| | - Rachael Kilding
- Department of Rheumatology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Daria A Kusevich
- Nasonova Research Institute of Rheumatology, Department of Rheumatology, Vidnoe, Russia
| | - Saskia Lawson-Tovey
- Department of MSK Research, Manchester Academic Health Science Centre, Manchester, UK.,UK and National Institute of Health Research Manchester, Department of Biomedical Research, Manchester, UK.,University of Manchester, Centre for Musculoskeletal Research, Centre for Genetics and Genomics Versus Arthritis, Manchester, UK.,Department of Biomedical Research, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jean Liew
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eoghan McCarthy
- Department of Rheumatology, Beaumont Hospital, Dublin, Ireland
| | - Anna Montgumery
- University of California San Francisco, Division of Rheumatology, Department of Medicine, San Francisco, California, USA.,VA Medical Center, Department of Health Research, San Francisco, California, USA
| | - Sebastian Moyano
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Noreen Nasir
- The Aga Khan University Hospital, Section of Internal Medicine, Department of Medicine, Karachi, Pakistan
| | - Ivan Padjen
- School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, Division of Immunology and Rheumatology, Department of Internal Medicine, Zagreb, Croatia
| | - Charalampos Papagoras
- Democritus University of Thrace, First Department of Internal Medicine, Alexandroupolis, Greece
| | - Naomi J Patel
- Massachusetts General Hospital, Division of Rheumatology, Allergy & Immunology, Boston, Massachusetts, USA
| | - Mariana Pera
- Hospital Angel C Padilla, Department of Rheumatology, Tucuman, Argentina
| | - Cecilia Pisoni
- CEMIC, Rheumatology and Immunology Section, Department of Internal Medicine, Buenos Aires, Argentina
| | - Guillermo Pons-Estel
- Sheffield Teaching Hospitals, NHS Foundation Trust, Department of Rheumatology, Sheffield, UK
| | - Antonio L Quiambao
- East Avenue Medical Center, Department of Rheumatology, Quezon City, Philippines
| | - Rosana Quintana
- Argenitine Society of Rheumatology, Research Unit, Buenos Aires, Argentina
| | - Eric Ruderman
- Northwestern University Feinberg School of Medicine, Department of Medicine/Rheumatology, Chicago, Illinois, USA
| | - Sebastian Sattui
- University of Pittsburgh, Department of Rheumatology, Pittsburgh, Pennsylvania, USA
| | | | - Savino Sciascia
- Osedale San Giovanni Bosco, Centro Multidisciplinare de Recerche di Immunopatologia e Documentazione su Malattie Rare (C.M.I.D.), Turin, Italy
| | - Marieta Sencarova
- Univerzitna Nemocnica L Pasteura, Department of Rheumatology, Slovakia
| | - Rosa Serrano Morales
- Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina
| | - Faizah Siddique
- Department of Rheumatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Emily Sirotich
- McMaster University, Department of Health Research, Evidence and Impact, Hamilton, Ontario, Canada
| | - Jeffrey Sparks
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Anja Strangfeld
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
| | - Paul Sufka
- Healthcare Partners, St Paul, Minnesota, USA
| | - Helen Tanner
- Royal Brisbane and Women's Hospital, Department of Rheumatology, Queensland, Australia.,University of Queensland, Royal Brisbane Clinical Unit, Queensland, Australia
| | | | - Zachary Wallace
- Massachusetts General Hospital, Division of Rheumatology, Allergy & Immunology, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Marina L Werner
- Hospital Nacional de Clinicas, Department of Rheumatology, Cordoba, Argentina
| | - Leanna Wise
- University of Southern California, Keck School of Medicine, Los Angelos, California, USA
| | - Angus B Worthing
- Department of Rheumatology, Arthritis and Rheumatism Associates PC, Washington, DC, USA.,Georgetown University Medical Center, Washington, DC, USA
| | - JoAnn Zell
- Division of Rheumatology, University of Colorado Health, Aurora, Colorado, USA
| | - Julija Zepa
- Department of Rheumatology, Paul Stradins Clinical University Hospital, Latvia, Riga.,Riga Stradins University, School of Medicine, Latvia, Riga
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK.,Department of Rheumatology, Northwick Park Hospital, London, UK
| | - Jinoos Yazdany
- University of California San Francisco, Division of Rheumatology, Department of Medicine, San Francisco, California, USA
| | - Philip Robinson
- Royal Brisbane and Women's Hospital, Department of Rheumatology, Queensland, Australia.,University of Queensland, Royal Brisbane Clinical Unit, Queensland, Australia.,Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
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Bermas BL, Gianfrancesco M, Tanner HL, Seet AM, Aguiar MC, Al Adhoubi NK, Al Emadi S, Cunha BM, Flood R, Kusevich DA, McCarthy EM, Patel NJ, Ruderman EM, Sattui SE, Sciascia S, Siddique F, Valenzuela-Almada MO, Wise LM, Worthing AB, Zell J, Bhana S, Costello W, Duarte-Garcia A, Grainger R, Gossec L, Hausmann JS, Hyrich K, Lawson-Tovey S, Liew JW, Sirotich E, Sparks JA, Sufka P, Wallace ZS, Machado PM, Strangfeld A, Clowse MEB, Yazdany J, Robinson PC. COVID-19 in Pregnant Women With Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance. J Rheumatol 2022; 49:110-114. [PMID: 34470798 DOI: 10.3899/jrheum.210480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
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.
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Affiliation(s)
- Bonnie L Bermas
- B.L. Bermas, MD, UTSouthwestern Medical Center, Dallas, Texas, USA
| | - Milena Gianfrancesco
- 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
| | - Helen L Tanner
- H.L. Tanner, MBChB, FRACP, University of Queensland School of Clinical Medicine, Faculty of Medicine, Queensland, Australia
| | - Andrea M Seet
- 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
| | - Mathia C Aguiar
- M.C. Aguiar, MD, Hospital General Agustin O'Horan, Merida, Mexico
| | - Nasra K Al Adhoubi
- N.K. Al Adhoubi, MD, FRCP, Rheumatology Unit, Royal Hospital, Muscat, Oman
| | - Samar Al Emadi
- S. Al Emadi, MBBS, FRCPC, Hamad Medical Corporation, Doha, Qatar
| | - Bernardo M Cunha
- B.M. Cunha, MD, PhD, Sarah Network of Rehabilitation Hospitals, Brasília, Brazil
| | - Rachael Flood
- R. Flood, MB, BCh, BAO, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Daria A Kusevich
- D.A. Kusevich, MD,PhD, V.A. Nasonova Research Institute of Rheumatology, Moscow, and Anikina Clinic, Vidnoe, Russia
| | - Eoghan M McCarthy
- E.M. McCarthy, MB, MRCPI, Manchester University Foundation Trust, Manchester, UK
| | - Naomi J Patel
- N.J. Patel, MD, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric M Ruderman
- E.M. Ruderman, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sebastian E Sattui
- S.E. Sattui, MD, MS, Hospital for Special Surgery, New York, New York, USA
| | - Savino Sciascia
- 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
| | - Faizah Siddique
- F. Siddique, MD, Loyola University Medical Center, Maywood, Illinois, USA
| | - Maria O Valenzuela-Almada
- M.O. Valenzuela-Almada, MBBS, A. Duarte-Garcia, MD, MS, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Leanna M Wise
- L.M. Wise, MD, University of Southern California, Los Angeles, California, USA
| | - Angus B Worthing
- A.B. Worthing, MD, Arthritis & Rheumatism Associates, PC, and Georgetown University Medical Center, Washington, DC, USA
| | - JoAnn Zell
- J. Zell, MD, University of Colorado, Aurora, Colorado, USA
| | - Suleman Bhana
- S. Bhana, MD, Crystal Run Healthcare, Middletown, New York, USA
| | - Wendy Costello
- W. Costello, Irish Children's arthritis network (iCan), Tipperary, Ireland
| | - Ali Duarte-Garcia
- M.O. Valenzuela-Almada, MBBS, A. Duarte-Garcia, MD, MS, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca Grainger
- R. Grainger, MBChB, PhD, FRACP, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Laure Gossec
- 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
| | - Jonathan S Hausmann
- 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
| | - Kimme Hyrich
- 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
| | - Saskia Lawson-Tovey
- 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
| | - Jean W Liew
- J.W. Liew, MS, MD, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily Sirotich
- E. Sirotich, BSc, Department of Health Research, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey A Sparks
- J.A. Sparks, MD, MMSc, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Sufka
- P. Sufka, MD, Healthpartners, St. Paul, Minnesota, USA
| | - Zachary S Wallace
- Z.S. Wallace, MD, MSc, Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Pedro M Machado
- 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
| | - Anja Strangfeld
- A. Strangfeld, MD, Epidemiology Unit, German Rheumatism Research Centre (DRFZ) Berlin, Berlin, Germany
| | - Megan E B Clowse
- M.E.B. Clowse, MD, MPH, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jinoos Yazdany
- 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
| | - Philip C Robinson
- 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.
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