Background:
Pregnant patients with coronavirus disease 2019 (COVID-19) are at risk for adverse pregnancy outcomes. Although clinical outcomes for pregnant adults have been reported, the impact of COVID-19 on adolescents is lacking. We sought to evaluate obstetric outcomes of pregnant adolescents infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and compare them with uninfected adolescent controls.
Methods:
Retrospective cohort study of pregnant adolescents (14–19 years) who had a positive polymerase chain reaction test for SARS-CoV-2 from April 2020 to December 2020 at Inova Health System Hospitals. Controls included pregnant adolescents who tested negative. The primary outcome was a composite of preeclampsia, preterm delivery, cesarean delivery, fetal growth restriction and stillbirth. Secondary outcomes included maternal and neonatal morbidity.
Results:
Forty-eight pregnant adolescents who tested positive for SARS-CoV-2 were compared with 394 controls. Infected adolescents were more likely to be Hispanic (91.67% vs. 12.18%; risk ratio [RR] 41.85 [95% CI: 15.43–113.5]) and uninsured (50% vs. 7.87%; RR 7.04 [95% CI: 4.31–11.49]. Nearly 80% of infected adolescents remained asymptomatic, whereas one-third of symptomatic adolescents progressed to severe or critical COVID-19. The primary composite outcome was more prevalent in infected adolescents compared with noninfected controls (41.67% vs. 25.38%; adjusted RR 2.65 [95% CI: 1.19–5.93]). Maternal morbidity was more prevalent in infected adolescents (6.25% vs. 0.76%; adjusted RR 9.53 [95% CI: 3.83–23.71]). Primary and secondary maternal outcomes were more prevalent in younger adolescents and those with higher severity of COVID-19. Maternal SARS-CoV-2 infection was not associated with neonatal morbidity.
Conclusions:
Pregnant adolescents infected with SARS-CoV-2 are more likely to have adverse obstetric outcomes and maternal morbidity compared with noninfected pregnant adolescents.
INTRODUCTION:Pregnancy carries increased risk factors for severe COVID-19 and adverse obstetric outcomes. Yet, it has not been evaluated whether increased risk during pregnancy varies with age. We sought to evaluate the risk of severity and adverse obstetric outcomes in SARS-CoV-2 positive adolescent patients compared to both non-infected adolescent and infected non-adolescent subjects.METHODS:Retrospective study across four Inova Health System Hospitals between March 2020 and January 2021. Patients were grouped by age and SARS-CoV-2 status: (i) adolescents (aged 14–19 years) SARS-CoV-2-positive, (ii) adolescents SARS-CoV-2-negative, and (iii) adults (age >20 years) SARS-CoV-2-positive. Statistical pairwise and regression analyses evaluated differences in disease distribution, severity, rates of prematurity, and cesarean delivery (CD) between group (i) and groups (ii) and (iii).RESULTS:Compared to SARS-CoV-2-negative adolescents (n=394), SARS-CoV-2-positive adolescents (n=48) were more likely to be Hispanic (91.7% versus 12.2%; adjusted P<.001), be uninsured (50% versus 7.9%; adjusted P<.001), require CD (25% versus 11.9%; adjusted P=.03), and deliver at greater gestational age (39 1/7 versus 38 4/7 weeks; adjusted P=.002). Compared to adult SARS-CoV-2-positive patients (n=695), adolescent SARS-CoV-2-positive patients were more likely to be Hispanic (91.7% versus 74.5%; adjusted P=.006), asymptomatic (79.2% versus 60.7%; adjusted P=.03), and to deliver at greater gestational age (39 1/7 versus 37 6/7 weeks; adjusted P=.004). We found no significant difference in the rates of prematurity, fetal growth restriction, NICU admission, and stillbirth.CONCLUSION:SARS-CoV-2 unequally affects Hispanic and uninsured adolescent pregnant patients. Infected adolescents are at high risk for CD compared to their non-infected adolescent counterparts. Infected pregnant adolescents tend to present with fewer COVID-19 symptoms compared to infected pregnant adults. Other obstetric outcomes were comparable among groups.
Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple gestation placentas. To our knowledge, there have been no reports of PAS in dichorionic placentas with different degrees of invasion. Here, we report dichorionic diamniotic placentas with two different degrees of invasion, one increta and another percreta.
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