HSS Presents Cutting-Edge Discoveries in Rheumatic Disease and Reproductive Health at ACR Convergence 2024

WASHINGTON, Nov. 18, 2024 /PRNewswire/ -- At this year's American College of Rheumatology (ACR) annual meeting, HSS presented several significant studies, with three focused on reproductive health: infant feeding behaviors among women with systemic rheumatic disease, the validation of a model that predicts the likelihood of adverse outcomes among pregnant patients with lupus, and a quality-improvement initiative to increase contraception screening and documentation.

What follows are highlights from these studies:

Factors Associated with Infant Feeding Behaviors Among Women with Systemic Rheumatic Diseases

While guidelines provide recommendations on which medications for rheumatic diseases are safe during breastfeeding, limited research has explored what factors influence the decision to breastfeed among patients with these conditions. HSS researchers leveraged data from the Rheumatology Women's Reproductive Health and Wellness Cohort to better understand the range of influences.

The cohort included 158 patients who reported on infant-feeding practices. Among those, 56% had systemic rheumatic diseases. The data showed that among these patients, about two-thirds breastfed at some point, while about one-third exclusively formula fed. The participants also reported their satisfaction levels with infant feeding, with only breast discomfort and lack of milk production being associated with lower satisfaction.

The investigators found that although the medications that the patients were taking for their rheumatic disease influenced their infant-feeding practices, disease-agnostic factors also played an important role. These factors included the experiences of friends and family, social media, and workplace policies, among others.

"It's important to be mindful that these are things that influence people's practices," says Sarah B. Lieber, MD, MS, rheumatologist at HSS.

Dr. Lieber explains that rheumatologists are uniquely positioned to study this topic, as they typically care for patients over many years, including during pregnancy and the postpartum period. "We develop close relationships with our patients and they frequently seek our guidance on a wide range of issues," she says. "Research like this allows us to expand our focus beyond rheumatology-specific concerns, addressing other important factors that may not have been addressed in other contexts to ensure that we honor their preferences with regard to infant feeding."

Authors: Sarah B. Lieber, MD, MS; Lucy Masto, BS; Amaya Smole, BA; Ranqing Lan, MA; Michael Parides, PhD; Jonah M. Levine, BA; Bessie Stamm, BA; Caroline H. Siegel, MD, MS; Lisa A. Mandl, MD, MPH; Michael D. Lockshin, MD; Medha Barbhaiya, MD, MPH; and Lisa R. Sammaritano, MD.

Predicting Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus: External Validation of the PROMISSE Model Using Multiple Independent Cohorts

Lupus is associated with severe adverse pregnancy outcomes, including pre-eclampsia, very early preterm deliveries, and in rare cases, fetal death. Fortunately, these occur in only 20% of patients. Early identification of women with SLE who are at high risk of pregnancy complications is vital. A team led by HSS investigators followed more than 400 pregnant patients with lupus — all of whom were enrolled in the PROMISSE Study, a multicenter, multiethnic/racial study — with the goal of using clinical features and laboratory tests to identify those patients at high risk for pregnancy complications. They identified two promising algorithms for predicting poor pregnancy outcomes using PROMISSE data.

The goal of the current work was to externally validate these two models to test their transportability to other populations. In this study, the group obtained data from 966 pregnant lupus patients from six independent cohorts treated at centers in the United States and Europe, a demonstration of global collaboration. Groups that shared data for the validation were from South Carolina, Manhattan, and the Bronx, as well as Germany, Italy, and France. The patient populations varied, with some groups being predominantly white, while others were predominantly Black — either African American or Afro-Caribbean.

The PROMISSE model used statistics and machine learning to create prediction algorithms based on thousands of data points from 400 patients. The new findings with the additional patients confirmed that the algorithms can reliably predict pregnancy outcomes by assessing factors such as the presence of specific autoantibodies, disease activity, blood pressure, medications, and patients' race and ethnicity. They demonstrate the geographic transportability of the best-performing algorithms. "The study reassured us that this model performs well across a diverse range of patient populations," says Jane E. Salmon, MD, co-principal investigator and rheumatologist at HSS.

"More than 80% of lupus patients are likely to have an uncomplicated pregnancy, and they should be able to enjoy this time without having to worry. We are now better able to predict risk," Dr. Salmon adds. "For those at higher risk, we can closely monitor and recommend clinical trials aimed at preventing complications."

The team also included co-principal investigator and biostatistician Mimi Kim, ScD, and machine learning expert Melissa Fazzari, MS, PhD. Their next step is to develop a publicly available online risk calculator, a tool to allow obstetricians, rheumatologists, and other healthcare providers to better guide their patients based on individualized assessments.

Authors: Melissa Fazzari (Albert Einstein College of Medicine); Jane E. Salmon, MD; Marta Guerra, MS; Nathalie Costedoat-Chalumeau (Inserm; Paris, France); Veronique Le Guern (Cochin Hospital; Paris, France); Gaëlle Guettrot-Imbert (Cochin Hospital, Paris, France); Marta Mosca (University of Pisa; Italy); Dina Zucchi (University of Pisa; Italy); Chiara Tani (University of Pisa; Italy); Rebecca Fischer-Betz (Uniklinik Düsseldorf, Düsseldorf, Germany); Isabell Haase (Heinrich-Heine University Düsseldorf; Düsseldorf, Germany); Anna Broder (Hackensack Network; New Jersey); Navneet Kaur (Touro University Medical Group, Sacramento); Jill Buyon (NYU Grossman School of Medicine); Brooke Cohen (NYU Grossman School of Medicine); Diane Kamen (Medical University of South Carolina); Jessica English (Medical University of South Carolina); Anna Arar (Medical University of South Carolina); and Mimi Kim (Albert Einstein College of Medicine).

Quality Improvement Initiative to Increase Contraception Screening and Documentation for Reproductive-Aged Women Prescribed Teratogenic Medications in an Academic Rheumatology Center

Contraception use among patients with rheumatologic diseases who are taking medications that may cause fetal defects is low. They are not always counseled on contraceptive options or prescribed effective contraception. In addition to primary care providers and gynecologists, rheumatologists play an important role in contraception counseling for patients with rheumatic disease. However, there are several barriers to rheumatologists providing contraception counseling to patients. Documentation of contraception use in patients with rheumatic disease is poorly standardized nationally. Researchers from HSS, who previously looked at developing a more streamlined process for documentation of sexual activity and contraception in these patients, expanded their work in this new study to improve documentation in this patient population.

In the study, they implemented a pop-up alert in the electronic health record across all ambulatory areas. Over a period of 24 weeks, the alert was set to trigger during clinical visits for female patients between the ages of 18 and 50 who were taking one of these high-risk medications. The alert reminded the nurses to ask about patients' sexual activity and contraceptive use and document it in the medical record.

Despite the initiative, the investigators found that for the most part, documentation rates did not increase significantly over the time period, except in the unit where the project had previously been piloted. "In that unit, we had nursing champions who were invested in the process and understood the importance of asking these questions," says Nancy Pan, MD, rheumatologist at HSS. "They can encourage their colleagues to help, including by suggesting ways to normalize what is often a sensitive topic with patients yet is critical to providing the best medical care possible for them." She adds that despite these results, she and her colleagues learned from this program and that their findings are prompting new interventions to optimize contraception documentation, counseling, and ultimately referrals to women's health providers.

"When patients choose to take these medications, we always make sure to counsel them on contraception," Dr. Pan says. "However, as a patient's personal circumstances can change, it's essential that we reassess their needs regularly. Optimizing documentation of contraception is an important first step to achieving improved health outcomes in these patients."

Authors: Caroline H. Siegel, MD, MS; Avi Mikhaylov; Emily Wu; Deanna Jannat-Khah, DrPH; Erika Abramson (Weill Cornell Medicine), Lisa R. Sammaritano, MD; and Nancy Pan, MD.^.

About HSS
HSS is the world's leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 15th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2024-2025), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report "Best Children's Hospitals" list (2024-2025). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

SOURCE Hospital for Special Surgery