Pregnancy Experiences of Women With Rheumatic Diseases During the COVID-19 Pandemic

Pregnancy was not associated with increased risk for coronavirus disease 2019 (COVID-19) in women with rheumatic disease who received care at an academic center in New York City; however, the majority of women reported changes in prenatal and perinatal care, according to survey results published in Arthritis Care & Research.

A web-based survey was sent by email to adult women who received care at the rheumatology clinic of a major academic center in New York City during the COVID-19 pandemic. Patients received up to 3 invitations between April 24, 2020 and May 17, 2020. The survey included sociodemographic and clinical factors occurring between January 1, 2020 and the date of survey completion. Pregnancy status was determined by self-report. Respondents were considered to have COVID-19 if they reported having a positive nasopharyngeal polymerase chain reaction (PCR) test or if they were diagnosed with COVID-19 by a health care provider. The Patient-Reported Outcomes Measurement Information System (PROMIS)-29 was used to measure rheumatic disease-related pain, fatigue, anxiety, and depression. Respondents who were pregnant were asked to describe their perceived impact of COVID-19 on prenatal and perinatal care. Study authors compared outcomes between pregnant and nonpregnant women, as well as between women with and without COVID-19.

A total of 1513 women (mean age, 38.1±8.0 years; 77% White) responded to the survey and completed the pregnancy questions in the survey, among whom 61 (4%) reported a pregnancy during the study period. Systemic rheumatic diseases occurred at similar rates in the pregnant and nonpregnant groups (67.2% and 74.0%, respectively; P =.24). Inflammatory arthritis was the most common rheumatic disease, reported by 36.1% of the study cohort. Undifferentiated connective tissue disease was less common among pregnant women compared with nonpregnant women (1.6% vs 8.8%; P =.049).

Survey results indicated that COVID-19 infection was not more common among pregnant vs nonpregnant respondents (8.2% vs 9.4%; P =.76). In addition, COVID-19 infection rates did not differ significantly by age, race/ethnicity, or presence of a systemic rheumatic disease. However, loss of taste or smell after a COVID-19 infection was much more common among pregnant vs nonpregnant women (100.0% vs 44.9%; P =.02).

Among all pregnant women, 67% reported perceived changes to prenatal care during the COVID-19 pandemic. Among women who completed their pregnancies during the survey period, 23% stated that COVID-19 had affected their deliveries. In particular, these women highlighted that no visitors were permitted in the delivery room and that they were encouraged to depart from the hospital soon after delivery. 

In the survey conducted in April during the peak of the COVID-19 pandemic, a significant percentage of pregnant women with rheumatic disease reported changes in their prenatal and perinatal care. Overall, COVID-19 infection rates were not higher among pregnant women compared with nonpregnant women.

The main study limitations were the small cohort size and sample homogeneity, with the majority of patients being White, non-Hispanic/Latina, and of high-income. In addition, the survey only enrolled women receiving care at 1 rheumatology clinic. Further study is necessary to assess pregnancy experiences among a more diverse representation of women.

“[O]ur finding of similar COVID-19 prevalence and disease severity in pregnant [vs] nonpregnant patients must be interpreted with caution, but provides helpful data to women with systemic rheumatic diseases contemplating pregnancy during the pandemic,” the study authors wrote.

Reference

Barbhaiya M, Stamm B, Vitone G, et al. Pregnancy and rheumatic disease: experience at a single center in New York City during the COVID-19 pandemic. Arthritis Care Res (Hoboken). Published online December 20, 2020. doi:10.1002/acr.24547