Are clinical outcomes worse for pregnant women at ≥20 weeks’ gestation infected with coronavirus disease 2019? A multicenter case-control study with propensity score matching

Badr, Dominique A.; Mattern, Jérémie; Carlin, Andrew; Cordier, Anne-Gaël; Maillart, Evelyne; Hachem, Larissa El; Kenz, Hanane El; Andronikof, M.; Bels, David De; Damoisel, Charles; Préseau, Thierry; Vignes, Dorothée; Cannie, Mieke; Vauloup‐Fellous, Christelle; Fils, Jean‐François; Benachi, Alexandra; Jani, Jacques; Vivanti, Alexandre J.

doi:10.1016/j.ajog.2020.07.045

Cited by 170 publications

(154 citation statements)

References 7 publications

(18 reference statements)

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“…Early identification of COVID-19 among hospitalized pregnant women can help ensure that health care providers use appropriate personal protective equipment and limit visitors to those essential for patients' well-being and care. ¶ The overall proportion of pregnant women with COVID-19 admitted to an ICU (7.4%) was similar to that observed in two European studies (7,8); however, 16.2% of symptomatic pregnant women in this study were admitted to an ICU, indicating that outcomes might be more severe among pregnant women admitted with acute illness than among those admitted for obstetric indications alone.…”

Section: Discussionsupporting

confidence: 86%

Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020

Delahoy¹

2020

MMWR Morb. Mortal. Wkly. Rep.

336

343

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, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Pregnant women might be at increased risk for severe coronavirus disease 2019 (COVID-19) (1,2). The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) (3) collects data on hospitalized pregnant women with laboratory-confirmed SARS-CoV-2, the virus that causes COVID-19; to date, such data have been limited. During March 1-August 22, 2020, approximately one in four hospitalized women aged 15-49 years with COVID-19 was pregnant. Among 598 hospitalized pregnant women with COVID-19, 54.5% were asymptomatic at admission. Among 272 pregnant women with COVID-19 who were symptomatic at hospital admission, 16.2% were admitted to an intensive care unit (ICU), and 8.5% required invasive mechanical ventilation. During COVID-19-associated hospitalizations, 448 of 458 (97.8%) completed pregnancies resulted in a live birth and 10 (2.2%) resulted in a pregnancy loss. Testing policies based on the presence of symptoms might miss COVID-19 infections during pregnancy. Surveillance of pregnant women with COVID-19, including those with asymptomatic infections, is important to understand the short-and long-term consequences of COVID-19 for mothers and newborns. Identifying COVID-19 in women during birth hospitalizations is important to guide preventive measures to protect pregnant women, parents, newborns, other patients, and hospital personnel. Pregnant women and health care providers should be made aware of the potential risks for severe COVID-19 illness, adverse pregnancy outcomes, and ways to prevent infection. COVID-NET conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations

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Section: Discussionsupporting

confidence: 86%

Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020

Delahoy¹

2020

MMWR Morb. Mortal. Wkly. Rep.

336

343

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“…Our results mirror the described clinical course of pregnant women infected with both COVID-19 and other respiratory viral illnesses (namely, influenza). 2 , 5 , 14 , 15 , 16 , 17 During the 2009 influenza pandemic (H1N1), pregnant women accounted for 5% of all deaths yet only represented 1% of the population, a marked disproportion in distribution of severe disease. 15 In a systematic review of H1N1, pregnancy was demonstrated to be a risk factor for hospitalization, intensive care unit admission, and death when compared to non-pregnant women of similar age.…”

Section: Discussionmentioning

confidence: 99%

“…3 Recent literature continues to support pregnancy as a risk factor for severe COVID-19. 4 , 5 However, the diagnosis of severe COVID-19 in these studies is heterogeneous, using primary outcomes such as intensive care unit admission or hospitalization as surrogate markers that are subject to misclassification bias in pregnant patients.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy as a risk factor for severe coronavirus disease 2019 using standardized clinical criteria

Oakes¹,

Kernberg²,

Carter³

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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more than 11 million people have been infected with coronavirus disease 2019 and almost 250,000 people have died from the disease in the United States, less than 1 year since its discovery. Although literature is beginning to emerge on pregnancy as a risk factor for severe coronavirus disease 2019, these studies are heterogeneous and use primary outcomes such as intensive care unit admission or hospitalization as surrogate markers that may subject analyses to misclassification bias in pregnant patients. OBJECTIVE: This study aimed to determine the risk of severe coronavirus disease 2019 among pregnant women with symptomatic coronavirus disease 2019 compared with nonpregnant women using nonadmissionbased, standardized clinical criteria for severe disease. STUDY DESIGN: This is a retrospective cohort study of women aged 13 to 45 years and diagnosed as having symptomatic coronavirus disease 2019 between May 28, 2020, and July 22, 2020. The primary outcome was severe coronavirus disease 2019 as defined by 2 sets of nonadmission-based, clinical criteria: the World Health Organization Ordinal Scale for Clinical Improvement and the Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Adjusted risk ratios were estimated using multivariable logistic regression analyses. RESULTS: Of 262 women aged 13 to 45 years with symptomatic coronavirus disease 2019, 22 (8.4%) were pregnant and 240 (91.6%) were nonpregnant. After adjusting for covariates potentially associated with the primary outcome, symptomatic pregnant women were at a significantly increased risk of severe coronavirus disease 2019 compared with nonpregnant women using both the World Health Organization Ordinal Scale for Clinical Improvement (adjusted relative risk, 3.59; 95% confidence interval, 1.49−7.01) and Novel Coronavirus Pneumonia Emergency Response Epidemiology Team (adjusted relative risk, 5.65; 95% confidence interval, 1.36−17.31) criteria. CONCLUSION: Pregnancy significantly increases the risk of severe coronavirus disease 2019 as defined by nonadmission-based, clinical criteria.

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“…Ellington et al described that amongst women with COVID 19, approximately one-third of pregnant women were hospitalised compared with 5.8% of non-pregnant women [13]. Similarly, higher risk of decompensation and complications were reported in the latter half of pregnancy by Badr et al [14] Most recently, reports with evidence of vertical transmission have been published [28,29]. Vivanti et al demonstrated the transplacental transmission, confirmed by comprehensive virological tests in the placenta, along with symptoms and clinical manifestations in the neonate [29].…”

Section: Introductionmentioning

confidence: 95%

Clinical profile, viral load, management and outcome of neonates born to COVID 19 positive mothers: a tertiary care centre experience from India

et al. 2020

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Despite rapidly evolving knowledge about COVID 19 infection, routes of perinatal COVID 19 transmission and viral load in mother neonate dyad remain uncertain. Data were analysed to describe the clinicodemographic profile and viral load in neonates born to COVID 19 positive mothers. Of 2947 deliveries, 69 mothers were COVID 19 positive (2.3%), with 1 abortion, 2 macerated stillbirths and 2 fresh stillbirths as pregnancy outcomes. Of 65 tested neonates, 10.7% (7) were confirmed COVID 19 positive by RTPCR (reverse transcriptase-polymerase chain reaction). Viral load (cycle threshold, Ct of E, RDRp) in neonates was comparable with the Ct reported from adults; however, neonates had milder clinical manifestations. All 7 neonates who tested positive for COVID 19 were subsequently discharged. Six of the 7 neonates were asymptomatic and 1 neonate needed respiratory support (indication being prematurity) which resolved after 48 h. Maternal and neonatal comparison of Ct of E and RdRp gene was statistically non-significant (25.97 vs 19.68, p = 0.34 and 26.5 vs 25.0, p = 0.84). Viral loads of mothers with COVID 19 positive neonates compared with mothers with COVID 19 negative neonates for E and RdRp gene were also statistically non-significant (25 vs 27.19, p = 0.63 and 19.6 vs 27.6, p = 0.08). The majority (93%) of neonates tested later than 48 h (roomed in with mother and breastfed) tested negative. Conclusion: The study supports milder manifestation in COVID 19 positive neonates. Risk of transmission from COVID 19 positive mother to neonate by rooming-in and breastfeeding is low. In this study on a limited number of neonates, maternal viral load was not found to be associated with the positivity status or severity of the illness of neonate.

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Are clinical outcomes worse for pregnant women at ≥20 weeks’ gestation infected with coronavirus disease 2019? A multicenter case-control study with propensity score matching

Cited by 170 publications

References 7 publications

Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020

Characteristics and Maternal and Birth Outcomes of Hospitalized Pregnant Women with Laboratory-Confirmed COVID-19 — COVID-NET, 13 States, March 1–August 22, 2020

Pregnancy as a risk factor for severe coronavirus disease 2019 using standardized clinical criteria

Clinical profile, viral load, management and outcome of neonates born to COVID 19 positive mothers: a tertiary care centre experience from India

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