Objective

Rituximab is a CD20-directed cytolytic antibody used for non-Hodgkin lymphoma, chronic lymphocytic leukaemia and RA, and off label for JIA, multiple sclerosis and lupus. Owing to concerns about infant B cell depletion, the manufacturer recommends avoidance of rituximab throughout pregnancy and for 12 months before conception. The aim of this study was to add to the limited data on pregnancy outcomes in women with exposure to rituximab.

Methods

Data were obtained from MotherToBaby Pregnancy Studies. Participants were enrolled prospectively into this observational study between 2007 and 2019. Pregnancy exposure and outcome data were collected from medical records, telephone interviews and dysmorphology examinations. The outcomes examined included spontaneous abortion, stillbirth, premature delivery, pregnancy complications, major and minor anomalies, small for gestational age, neonatal complications and serious infections.

Results

We classified 19 women with exposure to rituximab into three groups. Group A included three women who received rituximab during pregnancy. Group B included three women who received their last infusion before conception but had assumed pregnancy exposure owing to the long half-life of the drug. Group C included 13 women who used rituximab in the 2 years before pregnancy, with the last infusion given no sooner than five half-lives before conception. Three children had a major structural defect. Preterm delivery occurred in two pregnancies, and two infants were small for gestational age on birth weight. No cases of B cell depletion were reported.

Conclusion

No pattern of major structural anomalies or other adverse outcomes was reported in this case series.

Background

During the Zika virus (ZIKV) outbreak, an urgent need existed for strong partnerships to disseminate Zika-related information to pregnant women and women of child-bearing age.

Methods

The Centers for Disease Control and Prevention (CDC) partnered with MotherToBaby, a national organization experienced in providing information about exposures during pregnancy to healthcare providers and the public, to disseminate accurate information about ZIKV infection during pregnancy. Partnership activities included regular information sharing, cross-linking information for the public, and promoting common messaging. Following the ZIKV outbreak, we reviewed common inquiries received as well as key strategies and lessons learned from the partnership.

Results

Between June 2016 and June 2019, MotherToBaby received 5,387 Zika-related inquiries from the public and health care providers. The majority (90%) of inquires came from preconception, pregnant, and breastfeeding women. Concerns about travel, pregnancy, sexual transmission, and preconception guidelines comprised the top information requests. Live chat was the preferred method of communication for Zika-related inquiries. Key strategies and lessons learned from this partnership included: capitalizing on existing nationwide infrastructure and expertise, prominently referring to partners as a resource, promoting shared messaging using online resources and social media, holding regular calls to share information, and collecting data to identify common questions and revise messaging.

Conclusions

This examination of strategies, lessons learned, and metrics from MotherToBaby and CDC's partnership during the ZIKV outbreak can be applied to future partnerships to address emerging public health threats.