Characteristics and outcomes of pregnant women hospitalised with confirmed SARS-CoV-2 infection in the UK: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

Abstract

Objective: To describe a national cohort of pregnant women hospitalised with SARS-CoV-2 infection in the UK, identify factors associated with infection and describe outcomes, including transmission of infection, for mother and infant.Design: Prospective national population-based cohort study using the UK Obstetric Surveillance System (UKOSS). Setting: All 194 obstetric units in the UK Participants: 427 pregnant women admitted to hospital with confirmed Sars-CoV-2 infection between 01/03/2020 and 14/04/2020. 694 comparison women who gave birth between 01/11/2017 and 31/10/2018. Main outcome measures: Incidence of maternal hospitalisation, infant infection. Rates of maternal death, level 3 critical care unit admission, preterm birth, stillbirth, early neonatal death, perinatal death; odds ratios for infected versus comparison women.Results: Estimated incidence of hospitalisation with confirmed SARS-CoV-2 in pregnancy 4.9 per 1000 maternities (95%CI 4.5-5.4). The median gestation at symptom onset was 34 weeks (IQR 29-38). Black or other minority ethnicity (aOR 4.49, 95%CI 3.37-6.00), older maternal age (aOR 1.35, 95%CI 1.01-1.81 comparing women aged 35+ with those aged 30-34), overweight and obesity (aORs 1.91, 95%CI 1.37-2.68 and 2.20, 95%CI 1.56-3.10 respectively compared to women with a BMI<25kg/m 2 ) and pre-existing comorbidities (aOR 1.52, 95%CI 1.12-2.06) were associated with admission with SARS-CoV-2 during pregnancy. 247 women (58%) gave birth or had a pregnancy loss; 180 (73%) gave birth at term. 40 (9%) hospitalised women required respiratory support. Twelve infants (5%) tested positive for SARS-CoV-2 RNA, six of these infants within the first 12 hours after birth. Conclusions:The majority of pregnant women hospitalised with SARS-CoV-2 were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy.Most had good outcomes and transmission of SARS-CoV-2 to infants was uncommon. The strong

The tragedy of COVID‐19 in Brazil: 124 maternal deaths and counting

“…2 (Table 1), a figure which is 3.4 times higher than the total number of COVID-19-related maternal deaths reported throughout the rest of the world at the time of writing. [3][4][5][6][7] The current mortality rate is 12.7% in the Brazilian obstetric population, which is also higher than rates reported so far in the literature. 3,4,7 Notably, the mortality rate was higher for cases identified in the postpartum period than during pregnancy, likely reflecting the onset timing of COVID-19 symptoms.…”

Worldwide maternal deaths due to COVID‐19: A brief review

“…Comparability of available data is impaired due to methodological differences in studies. For example, Iran 8 reported critical cases only and denominators differ among other studies, such as mixed‐severity hospitalized cases (UK and France), 4,5 acute respiratory distress syndrome cases (Brazil), 6 and COVID‐19 pregnant women in general (US and Mexico) 3,7 . These preliminary data, however, expose the weaknesses of maternity services in middle‐income countries.…”

“…We searched PubMed/MEDLINE, EMBASE, SciELo and LILACS for documented COVID‐19‐related maternal deaths from December 2019 until July 1, 2020. After removal of duplicates, our results showed that six countries had reported maternal deaths due to COVID‐19 by July 1, 2020: three high‐income countries (France, UK, and US) 3–5 and three middle‐income countries (Brazil, Iran, and Mexico) 6–8 . The total number of reported maternal deaths was 160 (Table 1).…”

“…In Mexico, only 2 out of 7 women who died were admitted to ICU and received invasive respiratory support. On the other hand, it is worth mentioning that in high‐income countries such as the UK and US, black women and women from ethnic minorities were disproportionally affected by severe complications associated with COVID‐19 3,5 …”

Reply

“…In the UK, Knight et al . have published interim results from the NIHR‐funded UK Obstetric Surveillance System (UKOSS) study (https://www.npeu.ox.ac.uk/ukoss, http://www.isrctn.com/ISRCTN40092247), which provides reliable data on maternal and neonatal outcomes 2 .…”