Characteristics and Outcomes of 241 Births to Women With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection at Five New York City Medical Centers

Khoury, Rasha; Bernstein, Peter S.; DeBolt, Chelsea A.; Stone, Joanne; Sutton, Desmond; Simpson, Lynn L.; Limaye, Meghana; Roman, Ashley S.; Fazzari, Melissa; Penfield, Christina A.; Ferrara, Lauren; Lambert, Calvin; Nathan, Lisa M.; Wright, Rodney; Bianco, Angela; Wagner, Brian; Goffman, Dena; Gyamfi-Bannerman, Cynthia; Schweizer, William; Ávila, Karina; Khaksari, Bijan; Proehl, Meghan; Heitor, F.; Monro, Johanna; Keefe, David L.; D’Alton, Mary E.; Brodman, Michael; Makhija, Sonia K.; Dolan, Siobhan M.

doi:10.1097/aog.0000000000004025

Cited by 183 publications

(191 citation statements)

References 19 publications

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“…Eight studies (95 247 women) compared pregnant populations with non-pregnant populations,2526272829303132 and four studies (2230 women) compared pregnant women with covid-19 versus pregnant women without covid-19 33343536. Forty cohort studies reported on clinical manifestations (13 018 pregnant, 85 084 non-pregnant women),25262728293031323536373839404142434445464748495051525354555657585960616263646566 45 studies reported on covid-19 related maternal outcomes (14 094 pregnant, 85 169 non-pregnant women),2526272829303132353637383940414243454647484950515354555657585961626364656667…”

Section: Resultsmentioning

confidence: 99%

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

Allotey

Fernández

Bonet

et al. 2020

BMJ

1,684

137

2,039

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Objective To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). Design Living systematic review and meta-analysis. Data sources Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 26 June 2020, along with preprint servers, social media, and reference lists. Study selection Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. Data extraction At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. Results 77 studies were included. Overall, 10% (95% confidence interval 7% to14%; 28 studies, 11 432 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (39%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to report symptoms of fever (odds ratio 0.43, 95% confidence interval 0.22 to 0.85; I 2 =74%; 5 studies; 80 521 women) and myalgia (0.48, 0.45 to 0.51; I 2 =0%; 3 studies; 80 409 women) and were more likely to need admission to an intensive care unit (1.62, 1.33 to 1.96; I 2 =0%) and invasive ventilation (1.88, 1.36 to 2.60; I 2 =0%; 4 studies, 91 606 women). 73 pregnant women (0.1%, 26 studies, 11 580 women) with confirmed covid-19 died from any cause. Increased maternal age (1.78, 1.25 to 2.55; I 2 =9%; 4 studies; 1058 women), high body mass index (2.38, 1.67 to 3.39; I 2 =0%; 3 studies; 877 women), chronic hypertension (2.0, 1.14 to 3.48; I 2 =0%; 2 studies; 858 women), and pre-existing diabetes (2.51, 1.31 to 4.80; I 2 =12%; 2 studies; 858 women) were associated with severe covid-19 in pregnancy. Pre-existing maternal comorbidity was a risk factor for admission to an intensive care unit (4.21, 1.06 to 16.72; I 2 =0%; 2 studies; 320 women) and invasive ventilation (4.48, 1.40 to 14.37; I 2 =0%; 2 studies; 313 women). Spontaneous preterm birth rate was 6% (95% confidence interval 3% to 9%; I 2 =55%; 10 studies; 870 women) in women with covid-19. The odds of any preterm birth (3.01, 95% confidence interval 1.16 to 7.85; I 2 =1%; 2 studies; 339 women) was high in pregnant women with covid-19 compared with those without the disease. A quarter of all neonates born to mothers with covid-19 were admitted to the neonatal unit (25%) and were at increased risk of admission (odds ratio 3.13, 95% confidence interval 2.05 to 4.78, I 2 =not estimable; 1 study, 1121 neonates) than those born to mothers without covid-19. Conclusion Pregnant and recently pregnant women are less likely to manifest covid-19 related symptoms of fever and myalgia than non-pregnant women of reproductive age and are potentially more likely to need intensive care treatment for covid-19. Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe covid-19. Preterm birth rates are high in pregnant women with covid-19 than in pregnant women without the disease. Systematic review registration PROSPERO CRD42020178076. Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

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Section: Resultsmentioning

confidence: 99%

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

Allotey

Fernández

Bonet

et al. 2020

BMJ

1,684

137

2,039

View full text Add to dashboard Cite

show abstract

“…1); some studies reported data on > 1 pertinent outcome. Of these, there were 52 studies reporting results on obesity prevalence among patients with COVID-19 involving a total of 504,556 cases (8,9,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) (Table 2). There was signi cant evidence for heterogeneity across studies in all analyzes (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…The retrieval publications were screened and abstracted if they met the following inclusion criteria: a) Observational studies (cohort, case-control, cross-sectional, case series); b) Studies providing su cient information for the calculation of relative risk (RR) and / or odds ratio (OR), in cases which critical data were not reported in the eligible articles, we contacted authors; c) Studies reporting the prevalence of obesity in COVID-19 patients (primary outcome) and/or data on the association between obesity and following secondary outcomes: COVID-19 and COVID-19 severity (severe COVID-19 was de ned based on international guidelines or hospitalization, ICU (Intensive Care Unit) admission, need for mechanical ventilator, mortality due to COVID-19 or a combination of these) (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Duplicates, case reports, reviews, studies with insu cient data after contacting with authors, and abstracts were all excluded, but letters were included.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

WITHDRAWN: The Negative Impact of Obesity on the Occurrence and Prognosis of the 2019 Novel Coronavirus (COVID-19) Disease: A Systematic Review and Meta-Analysis

Raeisi

Mozaffari

Sepehri

et al. 2020

Preprint

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Background: the 2019 novel coronavirus (COVID-19) is an emerging pandemic, with a disease course varying from asymptomatic infection to critical disease resulting to death. Recognition of prognostic factors is essential because of its growing prevalence and high clinical costs. This meta-analysis aimed to evaluate the global prevalence of obesity in COVID-19 patients and to investigate whether obesity is a risk factor for the COVID-19, COVID-19 severity, and its poor clinical outcomes including hospitalization, intensive care unit (ICU) admission, need for mechanical ventilation, and mortality.Methods: The study protocol was registered on to PROSPERO (CRD42020203386). A systematic search of Scopus, Medline, and Web of Sciences was conducted on June 2020, to find pertinent studies. After selection, 54 studies from 10 different countries were included in the quantitative analyses. Pooled odds ratios (OR) with 95% confidence intervals (CIs) were calculated to assess the associations. Results: The prevalence of obesity was 33% (95% CI, 30.0%–35.0%) among patients with COVID-19. Obesity was significantly associated with susceptibility to COVID-19 (OR=2.42, 95% CI: 1.58 to 3.70; moderate certainty) and COVID-19 severity (OR=1.62, 95% CI: 1.48 to 1.76; low certainty). Furthermore, obesity was a significant risk factor for hospitalization (OR=1.75, 95% CI: 1.47 to 2.09; very low certainty), mechanical ventilation (OR=2.24, 95% CI: 1.70 to 2.94; low certainty), intensive care unit (ICU) admission (OR=1.75, 95% CI: 1.38 to 2.22; low certainty), and death (OR=1.23, 95% CI: 1.06 to 1.41; low certainty) in COVID-19 patients. In the subgroup analyses, these associations were supported by the majority of subgroups. Conclusions: Obesity is associated with COVID-19 and its poor clinical outcomes. Thus, it is highly recommended to consider obesity status in prognostic scores and improvement of guidelines for the clinical care of patients with COVID-19.

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“…In a study involving five major medical centers in NYC, among 241 pregnant women with SARS-CoV-2 infections admitted to the hospital for labor and delivery, a majority (61.4%) were asymptomatic. Throughout their hospitalization, 26.5% ultimately met criteria for mild, 26.1% for severe and only 5% for critical disease [ 36 ]. Similarly, to non-pregnant individuals, pregnant women with COVID-19 also revealed racial/ethnic inequities: A Boston study demonstrated that 39/54 (72%) of Hispanic but only 22/82 non-Hispanic women (27%; P < 0.001) had positive viral tests.…”

Section: To Be Pregnant During Covid-19mentioning

confidence: 99%

The COVID-19 pandemic through eyes of a NYC fertility center: a unique learning experience with often unexpected results

Gleicher

2020

Reprod Biol Endocrinol

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Affecting basic tenets of human existence such as health, economic as well as personal security and, of course, reproduction, the COVID-19 pandemic transcended medical specialties and professional disciplines. Yet, six months into the pandemic, there still exists no consensus on how to combat the virus in absence of a vaccine. Facing unprecedented circumstances, and in absence of real evidence on how to proceed, our organization early in the pandemic decided to act independently from often seemingly irrational guidance and, instead, to carefully follow a quickly evolving COVID-19 literature. Here described is the, likely, unique journey of a fertility center that maintained services during peaks of COVID-19 and political unrest that followed. Closely following publicly available data, we recognized relatively early that New York City and other East Coast regions, which during the initial COVID-19 wave between March and May represented the hardest-hit areas in the country, during the second wave, beginning in June and still in progress, remained almost completely unaffected. In contrast, south western regions, almost completely unaffected by the initial wave, were severely affected in the second wave. These two distinctively different infectious phenotypes suggested two likely explanations: The country was witnessing infections with two different SARS-CoV-2 viruses and NYC (along with the East Coast) acquired during the first wave much better immunity to the virus than south western regions. Both hypotheses since have been confirmed: East and West Coasts, indeed, were initially infected by two distinctively different lineages of the virus, with the East Coast lineage being 10-times more infectious. In addition, immunologists discovered an up to this point unknown long-term anti-viral innate (cellular) immune response which offers additional and much broader anti-viral immunity than the classical adaptive immunity via immobilizing antibodies that has been known for decades. Consequently, we predict that in the U.S., even in absence of an available vaccine, COVID-19, by September–October, will be at similarly low levels as are currently seen in NYC and other East Coast regions (generally < 1% test-positivity). We, furthermore, predict that, if current mitigation measures are maintained and no newly aggressive mutation of the virus enters the country, a significant fall-wave of COVID-19, in combination with the usual fall wave of influenza, appears unlikely. To continue serving patients uninterrupted throughout the pandemic, turned for all of our center’s staff into a highly rewarding experience, garnered respect and appreciation from patients, and turned into an absolutely unique learning experience.

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Characteristics and Outcomes of 241 Births to Women With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection at Five New York City Medical Centers

Abstract: LL, et al. Characteristics and outcomes of 241 births to women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at five New York City medical centers. Obstet Gynecol 2020;136. The authors provided this information as a supplement to their article.

Cited by 183 publications

References 19 publications

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

WITHDRAWN: The Negative Impact of Obesity on the Occurrence and Prognosis of the 2019 Novel Coronavirus (COVID-19) Disease: A Systematic Review and Meta-Analysis

The COVID-19 pandemic through eyes of a NYC fertility center: a unique learning experience with often unexpected results

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