Lack of vaccination results in a higher frequency of pre-term births in pregnant women with rheumatic disease and COVID-19

A study involving women with rheumatic and musculoskeletal diseases (RMDs) and SARS-CoV-2 infection during pregnancy evaluated the obstetric outcomes according to COVID-19 vaccination status. Unvaccinated women experienced a numerically higher occurrence of pre-term births than those who had received more than 1 dose of a COVID-19 vaccine.

A descriptive study explored the obstetric outcomes based on COVID-19 vaccination status in pregnant women with RMDs who developed COVID-19 during pregnancy [1]. All data was retrieved from the COVID-19 Global Rheumatology Alliance (C19 GRA) registry, which collects information on COVID-19 infections in patients with RMDs.

Dr Sinead Maguire (St. James’ Hospital, Ireland) and her research team selected pregnant women in the C19 GRA registry from 24 March 2020 to 25 February 2022. Additional data was collected via e-surveys sent to healthcare professionals who previously submitted data on pregnant patients to the C19 GRA registry.

The study stratified obstetric outcomes by the number of COVID-19 vaccine doses received before SARS-CoV-2 infection in pregnancy. “We defined those who have received 0 or 1 dose of COVID-19 vaccine as unvaccinated and those who had at least 2 doses as fully vaccinated,” Dr Maguire described.

There were 73 pregnancies in 73 women, with a mean age of 32.3 years. The most common RMD was systemic lupus erythematosus (23.3%, n=17), followed by rheumatoid arthritis (21.9%, n=16). RMD was in remission at the time of COVID-19 diagnosis in 69.9% (n=51) of the study cohort, whereas only 4.1% (n=3) exhibited severe disease activity. Others had mild to moderate disease status.

During the data collection period, 24.7% (n=18) of pregnancies were ongoing, while of the 55 completed pregnancies, 90.9% (n=50) resulted in live births. There was 1 miscarriage, 3 stillbirths, and 1 medical abortion for maternal health.

In the study cohort, 64.4% were unvaccinated (60.3% [n=44] had no dose received, 4.1% [n=3] received 1 dose), and the others were fully vaccinated. Although 20.5% (n=15) required hospital admission, only 16.4% (n=12) demanded COVID-19-specific pharmacological treatment.

COVID-19 infection during pregnancy was followed by delivery in 6.8% (n=3) of unvaccinated women and 3.8% (n=1) of vaccinated women. Moreover, of the completed pregnancies, there was a higher number of pre-term births in unvaccinated women than in vaccinated women (29.5% vs 18.2%; P=0.45).

The most frequent neonatal complication among live births was the low birth weight (birth weight <2500 g) recorded in 24% (12/50) of pregnancies.

In summary, unvaccinated pregnant women with RMDs and COVID-19 showed a trend towards an increased number of pre-term births than those fully vaccinated. "Our research findings support the active promotion of COVID-19 vaccination in women with RMD who are pregnant or planning a pregnancy," Dr Maguire concluded.

 

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   1. Maguire S, et al. 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. 0950, ACR Convergence 2022, 10–14 November, Philadelphia, USA.

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Posted on 1 December 202229 February 2024