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Background: Rheumatologic and musculoskeletal disorders can frequently affect women of childbearing age. These diseases, and the medications used to treat them, can have an impact on a woman’s fertility, pregnancy course, and fetal outcomes. The Specialty Care in Pregnancy (SCIP) clinic, at Women and Infant’s Hospital in Providence, Rhode Island, aims to provide a multidisciplinary approach to patient care consisting of obstetric-medicine specialists collaborating with rheumatologists. SCIP clinic provides medical care to women with rheumatologic conditions who are pregnant or planning to conceive. At a national level, the number of such combined specialty clinics is scarce.
Objectives: The goal of this study was to characterize the population cared for in this clinic, identify interventions provided to the patients, and analyze pregnancy outcomes.
Methods: We performed a 6-year retrospective analysis of medical records of patients seen in this multidisciplinary obstetric-medicine/rheumatology clinic from January 1, 2016 through December 31, 2022 using the REDcap database. The data extracted from the charts included patient’s demographics (age, ethnicity, rheumatological diagnoses, non-rheumatological diagnoses), interventions made (medications initiated at the initial visit and medications discontinued or changed), and the outcomes of the patients’ pregnancies (mode of delivery, fetal outcomes, and fetal complications).
Results: Data from 97 patients were extracted. The median age of the patients was 35 and the median gestational age at first visit was 17.5 weeks (IQR 4 – 38 weeks) (Table 1). 72 (74.2%) patients had a rheumatological diagnosis. 12 (12.3%) patients were diagnosed with a new rheumatological disease. Interventions: 41 (42.2%) had a medication initiated at the clinic (conventional DMARD, biologic DMARD, or others), 9 (9.2%) had a medication discontinued, and 12 (12.3%) had a change in dose of their medication. Outcomes: The pregnancy outcomes included 61 (62.8%) live births, 10 (10.3%) miscarriages and 1 (1.03%) termination of pregnancy, with 25 (25.7%) not reported (Table 2).
Conclusion: Our study demonstrates the benefits of multidisciplinary care of women with rheumatologic and musculoskeletal disorders during their prenatal, perinatal, and postpartum periods. This clinic provides the opportunity for obstetric-medicine internist and rheumatologist to make complex medical decisions together, weighing the risks and benefits of therapies for both the mother and fetus. Similar multidisciplinary clinics are needed worldwide, to provide highly valuable and comprehensive care to this high-risk patient population and to allow further clinical research of this unique and understudied population.
REFERENCES: NIL.
Characteristics of 97 patients seen in the obstetric-medicine/rheumatology clinic.
| Characteristics | n=97 |
|---|---|
| Age, median (IQR), years | 35 (21-38) |
| Ethnicity, n (%) | |
| White | 56 (57.7%) |
| Black or African-American | 9 (9.2%) |
| Asian | 4 (4.1%) |
| American-Indian | 1 (1.03%) |
| Multiracial | 6 (6.2%) |
| Not reported | 21 (21.6%) |
| Rheumatological diagnosis, n (%) | |
| Systemic lupus erythematous | 19 (19.5%) |
| Rheumatoid arthritis | 12 (12.3%) |
| ANA abnormality (≥ 1:160), undifferentiated | 13 (13.4%) |
| Psoriatic arthritis | 6 (6.1%) |
| Ankylosing spondylitis | 6 (6.1%) |
| Antiphospholipid syndrome | 4 (4.1%) |
| Others* | 37 (38.1%) |
*Others: Panuveitis, Behcet’s disease, Drug induced lupus, Vasculitis, Sjogren’s disease, Scleroderma, Discoid lupus, Mixed connective tissue and others.
Outcomes from 97 pregnant women seen in the obstetric-medicine/rheumatology clinic.
| Pregnancy Outcome, n (%) | |
|---|---|
| Live Birth. | 61 (62.8%) |
| Miscarriage | 10 (10.3%) |
| Unknown | 25 (25.7%) |
| Termination | 1 (1.03%) |
| Mode of Delivery, n (%) | |
| Cesarean section | 18 (18.5%) |
| Normal vaginal delivery | 18 (18.5%) |
| Assisted vaginal delivery | 2 (2.06%) |
| Unknown | 59 (60.8%) |
| Fetal complication, n (%) | |
| Prematurity (<37 weeks) | 4 (4.1%) |
| Intrauterine growth restriction | 2 (2.06%) |
| Respiratory complications | 2 (2.06%) |
| Infection | 1 (1.03%) |
| Fetal demise | 4 (4.1%) |
| complication on cDMARDs | 2 (2.06%) |
| complication on bDMARDs | 0 (0%) |
cDMARDs and bDMARDs =Conventional and Biologic disease-modifying antirheumatic drugs
Acknowledgements: NIL.
Disclosure of Interests: None declared.