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.