Abstract: FR-PO0971
Maternal and Neonatal Outcomes After Rituximab (RTX) Exposure During Pregnancy: A Systematic Review
Session Information
- Women's Health and Kidney Diseases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2100 Women's Health and Kidney Diseases
Authors
- Koubar, Sahar, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Zatreh, Mallak, The University of Kansas Medical Center, Kansas City, Kansas, United States
- Jdiaa, Sara Saleh, University of South Dakota, Vermillion, South Dakota, United States
- Mangalgi, Shreepriya, University of Missouri, Columbia, Missouri, United States
- Azzam, Muayad, The University of Kansas Medical Center, Kansas City, Kansas, United States
- Hoteit, Mayssaa, Bridgeport Hospital, Bridgeport, Connecticut, United States
- Mustafa, Reem Adel, The University of Kansas Medical Center, Kansas City, Kansas, United States
Background
We conducted a systematic review to evaluate safety of RTX exposure during pregnancy and its effects on maternal and neonatal outcomes
Methods
A systematic search of PubMed, Embase, and Cochrane was performed from inception through April 2026. Studies reporting RTX exposure during or within one year prior to pregnancy were included. Case reports/series were analyzed descriptively. Data from observational studies were pooled using a random-effects model. Risk of bias was formally assessed, and the certainty of evidence was graded using the GRADE approach
Results
After screening 2484 references, 19 eligible non-comparative non-randomized studies of interventions (NRSIs) and 135 case reports/series were included. These comprised 328 and 242 pregnancies, respectively. No RCTs or comparative NRSIs were identified. Among case reports/series, the most common indication for rituximab was malignancy (31%), followed by rheumatologic disease (23%). Most exposures occurred during the second and third trimesters (46.5%). Maternal infections occurred in 5.8% of cases, with maternal mortality reported in 1.7%. Mean gestational age was 35.6 ± 4.2 weeks and mean birth weight was 2,426 ± 798 g; 2.1% were stillbirths. Congenital anomalies occurred in 3.1% and neonatal infections in 8.2%. Meta-analysis of observational studies demonstrated an overall pooled maternal infection rate of 18%, mainly in those with malignancy. Pooled rates were 4% for congenital anomalies and neonatal infections, and 3.5% for neonatal mortality. Certainty of evidence of all outcomes was judged to be very low
Conclusion
Maternal outcomes after RTX exposure in pregnancy likely reflect the underlying indication, and neonatal outcomes appear reassuring; very low certainty of evidence limits definitive conclusions