Background/Purpose: Rheumatic disorders frequently affect women of childbearing age. These diseases and medications used to treat them can have adverse effects on fertility and fetuses. At The Women and Infant’s Hospital in Providence, Rhode Island, the Specialty Care in Pregnancy (SCIP) clinic provides a multidisciplinary patient care team consisting of obstetric-medicine internists collaborating with rheumatologists to care for women with rheumatologic conditions who are pregnant or hoping to become pregnant. At a national level, clinics combining these specialties are scarce with an internet search revealing only three other programs in the United States (The Brigham and Women’s Hospital, Tufts Hospital, and The Hospital for Special Surgery). The purpose of this study was to characterize the population cared for in this unique clinic, identify interventions provided by this clinic, and analyze pregnancy outcomes for the mother and child.

Methods: We performed a 5-year retrospective chart review of patients seen in the multidisciplinary obstetric-medicine/rheumatology clinic at The Women and Infants Hospital in Providence, Rhode Island, from January 1, 2016 through December 31, 2021. Outcomes extracted from the charts included: age, change to diagnosis, changes to medications, medical comorbidities, laboratory results, birth outcomes and complications, and services provided by the clinic.

Results: Demographics The data from 87 patients were extracted (Table 1). Additionally, the median gestational age at first visit was 17 weeks (IQR 11-26 weeks). 47% of patients had a primary rheumatologist prior to evaluation in clinic. Interventions 38 patients (44%) had a medication initiated at the clinic, 9 (10%) had a medication discontinued, and 7 (8%) had a change in dose of a medication (Table 2). 18 patients (21%) were referred to another specialist from the shared clinic, and 3 (3%) received fertility counseling and were referred to a fertility specialist. 8 patients (9%) were diagnosed with a new autoimmune condition. Outcomes Pregnancy outcomes are listed in Table 3. Additionally, 5 patients (6%) developed preeclampsia.

Conclusion: The Specialty Care in Pregnancy (SCIP) clinic is among the first obstetric-medicine/rheumatology multidisciplinary clinics in the United States (US) and the first to publish analysis of their data. Interventions were made in the majority of patients despite nearly half already having established care with a primary rheumatologist, which highlights the critical importance of this clinic. The most commonly initiated medications were hydroxychloroquine and prednisone, which underscores the safety and efficacy of these medications in preventing and treating flares during pregnancy. Compared with a similar clinic in the United Kingdom, our preeclampsia incidence was 6 times higher (6% vs 1%) and miscarriage incidence was 8 times higher (16% vs 2%) (1). These discrepancies may be attributed to differences in socioeconomic and racial diversity. Multidisciplinary clinics of this type are needed in the US to provide further care and research to this patient population. References: Hum RM, et al. Pregnancy outcomes of a joint obstetric and rheumatology clinic. Rheum Adv Pract. 2022 PMID: 35474882

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-multidisciplinary-obstetric-medicine-rheumatology-specialty-clinic-in-the-united-states-a-five-year-analysis/