Pregnant patients with severe or critical coronavirus disease 2019 (COVID-19), but not those with mild or moderate COVID-19, were at increased risk for perinatal complications compared with asymptomatic patients.

IMPORTANCEIt remains unknown whether SARS-CoV-2 infection specifically increases the risk of serious obstetric morbidity.OBJECTIVE To evaluate the association of SARS-CoV-2 infection with serious maternal morbidity or mortality from common obstetric complications.

ImportanceSARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.ObjectiveTo develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.Design, Setting, and ParticipantsProspective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.ExposureSARS-CoV-2 infection.Main Outcomes and MeasuresPASC and 44 participant-reported symptoms (with severity thresholds).ResultsA total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.Conclusions and RelevanceA definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.

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IMPORTANCE Administration of corticosteroids to women at high risk for delivery in the late preterm period (34–36 weeks’ gestation) improves short-term neonatal outcomes. The cost implications of this intervention are not known. OBJECTIVE To compare the cost-effectiveness of treatment with antenatal corticosteroids with no treatment for women at risk for late preterm delivery. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of the Antenatal Late Preterm Steroids trial, a multicenter randomized clinical trial of antenatal corticosteroids vs placebo in women at risk for late preterm delivery conducted from October 30,2010, to February 27,2015. took a third-party payer perspective. Maternal costs were based on Medicaid rates and included those of betamethasone, as well as the outpatient visits or inpatient stay required to administer betamethasone. All direct medical costs for newborn care were included. For infants admitted to the neonatal intensive care unit, comprehensive daily costs were stratified by the acuity of respiratory illness. For infants admitted to the regular newborn nursery, nationally representative cost estimates from the literature were used. Effectiveness was measured as the proportion of infants without the primary outcome of the study: a composite of treatment in the first 72 hours of continuous positive airway pressure or high-flow nasal cannula for 2 hours or more, supplemental oxygen with a fraction of inspired oxygen of 30% or more for 4 hours or more, and extracorporeal membrane oxygenation or mechanical ventilation. This secondary analysis was initially started in June 2016 and revision of the analysis began in May 2017. EXPOSURES Bethamethasone treatment. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio. RESULTS Costs were determined for 1426 mother-infant pairs in the betamethasone group (mean [SD] maternal age, 28.6 [6.3] years; 827 [58.0%] white) and 1395 mother-infant pairs in the placebo group (mean [SD] maternal age, 27.9 [6.2] years; 794 [56.9%] white). Treatment with betamethasone was associated with a total mean (SD) woman-infant-pair cost of $4681 ($5798), which was significantly less than the mean (SD) amount of $5379 ($8422) for women and infants in the placebo group (difference, $698; 95% Cl, $186-$1257; P = .02). The Antenatal Late Preterm Steroids trial determined that betamethasone use is effective: respiratory morbidity deceased by 2.9% (95% Cl, −0.5% to −5.4%). Thus, the cost-effectiveness ratio was −23 986. Inspection of the bootstrap replications confirmed that treatment was the dominant strategy in 5000 samples (98.8%). Sensitivity analyses showed that these results held under most assumptions. CONCLUSIONS AND RELEVANCE The findings suggest that antenatal betamethasone treatment is associated with a statistically significant decrease in health care costs and with improved outcomes; thus, this treatment may be an economically desirable strategy.

(Abstracted from JAMA 2022;327:748–759)It is well known that pregnant individuals with COVID-19 have increased risks such as admission to the intensive care unit (ICU), mechanical ventilation, and death when compared with both nonpregnant adults with SARS-CoV-2 infection and pregnant adults without SARS-CoV-2 infection. However, although COVID-19 is known to increase the risk of maternal morbidity related to the virus, the possibility for higher risk of serious morbidity from obstetric complications is not clear.

Objective To evaluate the association between documentation of estimated fetal weight, and its value, with cesarean delivery. Methods This was a secondary analysis of a multi-center observational cohort of 115,502 deliveries from 2008 to 2011. Data were abstracted by trained and certified study personnel. We included women ≥37 weeks attempting vaginal delivery with live, non-anomalous, singleton, vertex fetuses, and no history of cesarean delivery. Rates and odds ratios were calculated for women with ultrasound or clinical estimated fetal weight, compared to women without documentation of estimated fetal weight. Further subgroup analyses were performed for estimated fetal weight categories (<3,500, 3,500 to 3,999, and ≥4,000 grams) stratified by diabetic status. Multivariable analyses were performed to adjust for important potential confounding variables. Results We included 64,030 women. Cesarean delivery rates were 18.5% in the ultrasound estimated fetal weight (EFW) group, 13.4% in the clinical EFW group, and 11.7% in the no documented EFW group (p < 0.001). After adjustment (including for birth weight), the adjusted OR (aOR) of cesarean delivery was 1.44 (95% CI 1.31–1.58, p<0.001) for women with ultrasound EFW and 1.08 for clinical EFW (95% CI 1.01–1.15, p=0.017), compared to women with no documented EFW (referent). The highest estimates of fetal weight conveyed the greatest odds of cesarean delivery. When ultrasound EFW was ≥4,000 grams, the aOR was 2.15 (95% CI 1.55–2.98, p<0.001) in women without diabetes, and 9.00 (95% CI 3.65–22.17, p<0.001) in women with diabetes, compared to those with EFW <3,500 grams. Conclusion In this contemporary cohort of women attempting vaginal delivery at term, documentation of estimated fetal weight (obtained clinically or, particularly, by ultrasound) was associated with increased odds of cesarean delivery. This relationship was strongest at higher fetal weight estimates, even after controlling for the effects of birth weight and other factors associated with increased cesarean delivery risk.

(Am J Obstet Gynecol. 2020;222:369.e1–369.e11) The A Randomized Trial of Induction Versus Expectant Management (ARRIVE) trial was conducted to analyze the effects of planned elective induction of labor on 6000 low-risk nulliparous women in comparison with expectant management. The ARRIVE trial found that planned elective labor induction at 39 weeks resulted in decreased cesarean delivery, fewer pregnancies with hypertensive disorders, and decreased neonatal respiratory morbidity. The aim of the current study was to compare health care resource utilization between planned elective induction of labor at 39 weeks and expectant management in nulliparous women during 3 time periods: antepartum, delivery admission, and discharge until 8 weeks postpartum.