0950: Obstetric Outcomes in Women with Rheumatic Disease and COVID-19 in the Context of Vaccination Status: Data from the COVID-19 Global Rheumatology Alliance Registry

Sinead Maguire¹, Samar Al emadi², Paul Alba³, Mathia C Aguiar⁴, Talal Al Lawati⁵, Gelsomina Alle⁶, Bonnie Bermas⁷, Suleman Bhana⁸, Branimir Anic⁹, Inita Bulina¹⁰, Megan Clowse¹¹, Adriana Karina Cogo¹², Iris Colunga¹³, Claire Cook¹⁴, KAREN JOYCE CORTEZ¹⁵, Kathryn Dao¹⁶, Milena Gianfrancesco¹⁷, Monique Gore-Massy¹⁸, Laure Gossec¹⁹, Rebecca Grainger²⁰, Jonathan Hausmann²¹, Tiffany YT Hsu²², Kimme Hyrich²³, Carolina Isnardi²⁴, Yumeko Kawano²², Rachael Kilding²⁵, Daria A Kusevich²⁶, Saskia Lawson-Tovey²⁷, Jean Liew²⁸, Eoghan McCarthy²⁹, Anna Montgomery³⁰, Sebastian Moyano³, Noreen Nasir³¹, IVAN PADJEN³², Charalampos Papagoras³³, Naomi Patel³⁴, MARIANA PERA³⁵, Cecilia Pisoni³⁶, Guillermo Pons-Estel³⁷, Antonio Lorenzo Quiambao³⁸, Rosana Quintana³⁹, Eric Ruderman⁴⁰, Sebastian Sattui⁴¹, Veronica Savio⁴², Savino Sciascia⁴³, Marieta Sencarova⁴⁴, Rosa Serrano-Morales⁴⁵, Faizah Siddique⁴⁶, Emily Sirotich⁴⁷, Jeffrey Sparks⁴⁸, Anja Strangfeld⁴⁹, Paul Sufka⁵⁰, Helen Tanner⁵¹, Yohana Tissera⁵², Zachary Wallace¹⁴, Marina Werner⁵³, Leanna Wise⁵⁴, Angus Worthing⁵⁵, JoAnn Zell⁵⁶, Julija Zepa¹⁰, Pedro Machado⁵⁷, Jinoos Yazdany¹⁷, Philip Robinson⁵¹ and Richard Conway¹,¹St James' Hospital, Dublin, Ireland, ²Hamad Medical Corporation, Doha, Qatar, ³Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, ⁴Hospital General Agustin O`Horan, Merida, Mexico, ⁵Sultan Qaboos University Hospital, Muscat, Oman, ⁶Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, ⁷UT Southwestern, Dallas, TX, ⁸Crystal Run Healthcare, Middletown, NY, ⁹Clinical Hospital Centre Zagreb, School of Medicine, University of Zagreb, Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Zagreb, Croatia, ¹⁰Center of Rheumatology, Paul Stradins Clinical University hospital, Riga, Latvia, ¹¹Duke University, Durham, NC, ¹²Hospital Interzonal Luis Guemes, Haedo and Hospital San Juan de Dios, Castelar, Buenos Aires, Argentina, ¹³Hospital Universitario UANL, Monterrey, Mexico, ¹⁴Massachusetts General Hospital, Boston, MA, ¹⁵Baguio General Hospital Medical Center, Baguio, Philippines, ¹⁶UT Southwestern Medical Center, Dallas, TX, ¹⁷University of California San Francisco, San Francisco, CA, ¹⁸Covid-19 GRA, West Orange, NJ, ¹⁹Sorbonne Université, Paris, France, ²⁰University of Otago, Wellington, New Zealand, ²¹Division of Immunology, Boston Children's Hospital, Boston, MA, ²²Brigham and Women's Hospital, Boston, MA, ²³The University of Manchester, Manchester, United Kingdom, ²⁴SAR-COVID Coordinator, Research Unit Argentine Society of Rheumatology, Buenos Aires, Argentina, ²⁵Sheffield teaching hospitals trust, Sheffield, United Kingdom, ²⁶VA Nasonova Research Institute of Rheumatology, Moscow and Anikina Clinic, Vidnoe, Russia, ²⁷Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, the University of Manchester, Manchester, UK AND National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom, ²⁸Boston University, Boston, MA, ²⁹Beaumont Hospital, Dublin, Ireland, ³⁰University of California, San Francisco, USA; San Francisco VA Medical Center, San Francisco, USA, San Francisco, CA, ³¹Aga Khan University Hospital, Karachi Pakistan, Karachi, Pakistan, ³²University Hospital Center Zagreb, Zagreb, Croatia, ³³First Department of Internal Medicine and Laboratory of Molecular Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece, ³⁴Massachusetts General Hospital, Sale Creek, TN, ³⁵Hospital Ángel C Padilla, San Miguel de Tucumán, Tucuman, Argentina, ³⁶CEMIC- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina, ³⁷Argentine Society of Rheumatology, Buenos Aires, Argentina, ³⁸East Avenue Medical Center, Quezon City, Philippines, ³⁹Centro Regional de Enfermedades Autoinmunes y Reumáticas. Grupo Oroño (GO CREAR) and Research Unit Argentine Society of Rheumatology, Buenos Aires, Argentina, ⁴⁰Northwestern University Feinberg School of Medicine, Chicago, IL, ⁴¹University of Pittsburg, Pittsburg, Pennsylvania, USA, PIttsburgh, PA, ⁴²Hospital Córdoba; Consultora Integral de Salud CMP, Cordoba, Argentina, ⁴³University of Turin, Torino, Italy, ⁴⁴Univerzitna nemocnica L Pasteura, Slovakia, Kosice, Slovakia, ⁴⁵Sanatorio Parque. Centro de Enfermedades Autoinmunes y Reumáticas del Grupo Oroño, Rosario, Argentina, ⁴⁶Loyola University Medical Center, Elmhurst, IL, ⁴⁷Department of Health Research, Evidence and Impact, McMaster University, Hamilton, ON, Canada, ⁴⁸Brigham and Women's Hospital and Harvard Medical School, Boston, MA, ⁴⁹Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany, ⁵⁰HealthPartners, Eagan, MN,⁵¹University of Queensland School of Medicine, Brisbane, Queensland, Australia, ⁵²Internal Medicine Service, Rheumatology Unit, Hospital Córdoba y Sanatorio Parque de Córdoba, Córdoba, Argentina, ⁵³Hospital Nacional de Clínicas, Córdoba, Argentina, ⁵⁴LAC+USC/Keck Medicine of USC, Pasadena, CA, ⁵⁵Arthritis & Rheumatism Associates, PC, Washington, DC, ⁵⁶University of Colorado Anschutz Medical Campus, Aurora, CO, ⁵⁷Centre for Rheumatology & Department of Neuromuscular Diseases, University College London and National Institute for Health Research (NIHR), University College London Hospitals NHS Foundation Trust, and Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom

Background/Purpose: 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: We extracted data on pregnant women who were entered into the COVID-19 Global Rheumatology Alliance (C19 GRA) registry from 24 March 2020 to 25 February 2022. Supplemental data collection was carried out via e-surveys sent to healthcare professionals who previously submitted data on pregnant patients to the C19 GRA registry. Obstetric outcomes were stratified by the number of COVID-19 vaccine doses received prior to COVID-19 infection in pregnancy. Partially or unvaccinated was defined as 0 to 1 dose of COVID-19 vaccine, while fully vaccinated was defined as 2 or more doses. None of the participants received the single dose Johnson & Johnson vaccine. Descriptive differences between groups were tested for statistical significance using the Chi-square or Fisher’s exact test.

Results: There were 73 pregnancies in 73 women (mean [SD] age of 32.3 [5.1] years) with RMD and COVID-19. Systemic lupus erythematosus was the most common RMD (23.3%, n=17), followed by rheumatoid arthritis (21.9%, n=16) (table 1). RMD was in remission at the time of COVID-19 diagnosis in 69.9% (51) of patients, with only 4.1% (3) reporting severe disease activity.

At the time of data extraction, 24.7% (18) of pregnancies were ongoing, while of the 55 completed pregnancies 90.9% (50) of pregnancies resulted in livebirths. Overall, 1.4% (1) of pregnancies resulted in miscarriage, 1.4% (1) in termination for maternal health and 4.1% (3) in stillbirths. At the time of COVID-19 diagnosis, 60.3% (44) of women were unvaccinated, 4.1% (3) had received one dose while 35.6% (26) had two or more doses (table 2). Although 20.5% (15) required hospital admission, only 16.4% (12) of women required COVID-19 specific pharmacological treatment.

COVID-19 precipitated delivery in 6.8% (3) of unvaccinated women and 3.8%(1) of fully vaccinated women. Of the completed pregnancies there was a greater number of preterm births (PTB) in unvaccinated women compared to fully vaccinated women (29.5% vs 18.2%) (table 3). Low birthweight (LBW) was the most frequent neonatal complication recorded in 24% (12/50) of pregnancies resulting in live births, followed by small for gestational age (SGA) in 14% (7/50).

Conclusion: This multinational analysis of obstetric outcomes in women with RMDs and COVID-19 using data from the C19-GRA registry is unique in the inclusion of vaccination data. In this descriptive study, unvaccinated pregnant women with RMD and COVID-19 had a higher frequency of PTB compared to 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 of women with RMD who are pregnant or planning a pregnancy.
Table 1: Characteristics of Pregnant Women with RMDs & COVID-19 infection

Table 2: Pregnancy characteristics of women with RMDs following COVID-19 infection in pregnancy by number of doses of COVID-19 vaccination received

Table 3: Pregnancy Outcomes stratified by Vaccination Status in Women with RMDs & COVID-19 Results reported as % (n).
Disclosures: S. Maguire, None; S. Al emadi, None; P. Alba, Pfizer, AbbVie/Abbott, Elea Phoenix, International League of Associations of Rheumatology; M. Aguiar, None; T. Al Lawati, None; G. Alle, None; B. Bermas, Bristol-Myers Squibb(BMS), Novartis; S. Bhana, None; B. Anic, None; I. Bulina, AbbVie/Abbott, AstraZeneca, Janssen, Novartis; M. Clowse, Exagen; A. Cogo, AbbVie/Abbott, Pfizer, Elea Phoenix, International League of Associations of Rheumatology; I. Colunga, None; C. Cook, None; K. CORTEZ, None; K. Dao, Bristol-Myers Squibb(BMS), Novartis, Rheumnow, Rheum101; M. Gianfrancesco, Pfizer; M. Gore-Massy, Aurinia Pharmaceuticals, Janssen, Bristol-Myers Squibb(BMS); L. Gossec, Amgen, Lilly, Pfizer, Sandoz, UCB Pharma, AbbVie, Bristol Myers Squibb, Gilead, Janssen, Novartis, Samsung Bioepis, Sanofi-Aventis, Galapagos, GlaxoSmithKlein (GSK), Celltrion, MSD; R. Grainger, AbbVie/Abbott, Janssen, Novartis, Pfizer, Cornerstones; J. Hausmann, Novartis, Pfizer, Biogen; T. Hsu, None; K. Hyrich, AbbVie/Abbott, Pfizer, Bristol-Myers Squibb(BMS); C. Isnardi, AbbVie/Abbott, Pfizer, Elea Phoenix, International League of Associations of Rheumatology; Y. Kawano, None; R. Kilding, None; D. Kusevich, None; S. Lawson-Tovey, None; J. Liew, None; E. McCarthy, None; A. Montgomery, None; S. Moyano, Pfizer, AbbVie/Abbott, Elea Phoenix, International League of Associations of Rheumatology; N. Nasir, None; I. PADJEN, Novartis, AbbVie/Abbott, Medis, Eli Lilly, Sandoz; C. Papagoras, Pharmaserve-Lilly, Faran, Elpen, Demo, AbbVie/Abbott, Genesis, Pharmaserve-Lilly, UCB, GlaxoSmithKlein(GSK), Pfizer, Janssen; N. Patel, FVC Health; M. PERA, None; C. Pisoni, AbbVie/Abbott, Pfizer, Elea Phoenix, International League of Associations of Rheumatology; G. Pons-Estel, AbbVie/Abbott, Pfizer, Elea Phoenix, International League of Associations of Rheumatology; A. Quiambao, None; R. Quintana, None; E. Ruderman, None; S. Sattui, None; V. Savio, AbbVie/Abbott, Pfizer, Elea Phoenix, International League of Associations of Rheumatology; S. Sciascia, None; M. Sencarova, None; R. Serrano-Morales, Pfizer, AbbVie/Abbott, Elea Phoenix, International League of Associations of Rheumatology; F. Siddique, None; E. Sirotich, None; J. Sparks, Bristol Myers Squibb, AbbVie/Abbott, Amgen, Boehringer Ingelheim, Gilead, Inova Diagnostics, Janssen, Optum, Pfizer; A. Strangfeld, AbbVie/Abbott, Merck/MSD, Roche, Bristol-Myers Squibb(BMS), Pfizer; P. Sufka, None; H. Tanner, None; Y. Tissera, Pfizer, AbbVie/Abbott, Elea Phoenix, International League of Associations of Rheumatology; Z. Wallace, Sanofi, Bristol-Myers Squibb(BMS), Zenas Biopharma, Horizon, Shionogi; M. Werner, AbbVie/Abbott, Pfizer, Elea Phoenix, International League Associations of Rheumatology; L. Wise, Aurinia Pharma; A. Worthing, None; J. Zell, None; J. Zepa, AbbVie/Abbott, Novartis, Janssen, AstraZeneca; P. Machado, None; J. Yazdany, AstraZeneca, AstraZeneca, Bristol-Myers Squibb(BMS), Gilead, Pfizer, Aurinia; P. Robinson, Pfizer, AbbVie/Abbott, Novartis, UCB, GlaxoSmithKlein(GSK), Janssen, Eli Lilly, Kukdong, Atom Biosciences; R. Conway, Janssen, Roche, Sanofi, AbbVie/Abbott, Janssen, AbbVie/Abbott.