Pregnancy Outcomes from a Multidisciplinary Obstetric-Medicine/Rheumatology Clinic in the United States: A Five-Year Retrospective Analysis

Abstract

Objective: At Women & Infants Hospital in Providence, Rhode Island, the Specialty Care in Pregnancy clinic combines obstetric-medicine internists with rheumatologists to care for pregnant patients with rheumatologic conditions. These clinics are scarce, with only three known similar clinics in the United States. This study aims to characterize the population cared for in this clinic, identify interventions, and analyze pregnancy outcomes for the birthing parents and newborns.

Methods: A five-year retrospective chart review was performed from January 1st, 2016, through December 31st, 2021.

Results: Of 81 patients, 62% had a clinically diagnosed rheumatic disorder. Of 87 patient visits, which included preconception, prenatal, and postpartum encounters, 54% of patients were taking conventional synthetic disease modifying antirheumatic drugs, and 17% were taking biologic disease modifying antirheumatic drugs. New medications were started in 52% of patients. A total of 52% of pregnancies resulted in live births, with 2% resulting in miscarriages. Prematurity occurred in 19% of newborns, and 9% had intrauterine growth restriction.

Conclusion: Our study illustrates the benefits of multidisciplinary care in patients with rheumatologic disorders during their prenatal and perinatal periods. The expertise from both the obstetric-medicine internists and rheumatologists was critical in making complex decisions that weighed the benefits of therapy against potential risks for the fetus. Our multidisciplinary approach resulted in doubling of the number of patients initiating disease modifying therapy and increased prophylaxis with hydroxychloroquine and/or aspirin therapy, as recommended by current guidelines. Additional multidisciplinary clinics of this type would help coordinate care among physicians who frequently treat these high-risk, unique patients and open the door for more research of this understudied population.