Background COVID-19 may be associated with adverse maternal and neonatal outcomes in pregnancy, but there is little controlled data to quantify the magnitude of these risks or to characterize the epidemiology and risk factors. Objective To quantify the associations of COVID-19 with adverse maternal and neonatal outcomes in pregnancy and to characterize the epidemiology and risk factors. Methods We performed a matched case-control study of pregnant patients with confirmed COVID-19 (cases) who delivered between 16 and 41 weeks’ gestation from March 11-June 11, 2020. Uninfected pregnant women (controls) were matched to COVID-19 cases on a 2:1 ratio based on delivery date. Maternal demographic characteristics, COVID-19 symptoms, laboratory evaluations, obstetrical and neonatal outcomes, and clinical management were chart abstracted. The primary outcomes included (i) a composite of adverse maternal outcome, defined as preeclampsia, venous thromboembolism, antepartum admission, maternal intensive care unit admission, need for mechanical ventilation, supplemental oxygen, or maternal death; and (ii) a composite of adverse neonatal outcome, defined as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, five-minute Apgar score <5, persistent category 2 fetal heart rate tracing despite intrauterine resuscitation, or neonatal death. In order to quantify the associations between exposure to mild and severe/critical COVID-19 and adverse maternal and neonatal outcomes, unadjusted and adjusted analyses were performed using conditional logistic regression (to account for matching), with matched-pair odds ratio (OR) and 95% confidence interval (CI) based on 1000 bias-corrected bootstrap resampling as the effect measure. Associations were adjusted for potential confounders. Results 61 confirmed COVID-19 cases were enrolled during the study period (mild disease: n=54, 88.5%; severe disease: n=6, 9.8%; and critical disease: n=1, 1.6%). The odds of adverse composite maternal outcome were 3.4 times higher among cases compared to controls (18.0% versus 8.2%, adjusted OR 3.4, 95% CI 1.2-13.4). The odds of adverse composite neonatal outcome were 1.7 times higher in the case group compared to the control group (18.0% versus 13.9%, adjusted OR 1.7, 95% CI 0.8-4.8). Stratified analyses by disease severity indicated that the morbidity associated with COVID-19 in pregnancy was largely driven by the severe/critical disease phenotype. Major risk factors for associated morbidity were Black and Hispanic race, advanced maternal age, medical comorbidities, and antepartum admissions related to COVID-19. Conclusions COVID-19 during pregnancy is associated with increased risk for adverse maternal and neonatal outcomes, an association that is primarily driven by morbidity associated with severe/critical COVID-19. Black and Hispanic race, obesity, advanced maternal age, medical comorbiditi...

IMPORTANCE Citation analysis is a bibliometric method that uses citation rates to evaluate research performance. This type of analysis can identify the articles that have shaped the modern history of obstetrics and gynecology (OBGYN). OBJECTIVES To identify and characterize top-cited OBGYN articles in the Institute for Scientific Information Web of Science's Science Citation Index Expanded and to compare top-cited OBGYN articles published in specialty OBGYN journals with those published in nonspecialty journals. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional bibliometric analysis of top-cited articles that were indexed in the Science Citation Index Expanded from 1980 to 2018. The Science Citation Index Expanded was queried using search terms from the American Board of Obstetrics and Gynecology's 2018 certifying examination topics list. The top 100 articles from all journals and the top 100 articles from OBGYN journals were evaluated for specific characteristics. Data were analyzed in March 2019. MAIN OUTCOMES AND MEASURES The articles were characterized by citation number, publication year, topic, study design, and authorship. After excluding articles that featured on both lists, top-cited articles were compared. RESULTS The query identified 3 767 874 articles, of which 278 846 (7.4%) were published in OBGYN journals. The top-cited article was published by Rossouw and colleagues in JAMA (2002). Top-cited articles published in nonspecialty journals were more frequently cited than those in OBGYN journals (median [interquartile range], 1738 [1490-2077] citations vs 666 [580-843] citations, respectively; P < .001) and were more likely to be randomized trials (25.0% vs 2.2%, respectively; difference, 22.8%; 95% CI, 13.5%-32.2%; P < .001). Whereas articles from nonspecialty journals focused on broad topics like osteoporosis, articles from OBGYN journal focused on topics like preeclampsia and endometriosis. CONCLUSIONS AND RELEVANCE This study found substantial differences between top-cited OBGYN articles published in nonspecialty vs OBGYN journals. These differences may reflect the different goals of the journals, which work together to ensure optimal dissemination of impactful articles.

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