Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State

Abstract

BACKGROUND: The impact of coronavirus disease 2019 on pregnant women is incompletely understood, but early data from case series suggest a variable course of illness from asymptomatic or mild disease to maternal death. It is unclear whether pregnant women manifest enhanced disease similar to influenza viral infection or whether specific risk factors might predispose to severe disease. OBJECTIVE: To describe maternal disease and obstetrical outcomes associated with coronavirus disease 2019 in pregnancy to rapidly inform clinical care. STUDY DESIGN: This is a retrospective study of pregnant patients with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 6 hospital systems in Washington State between Jan. 21, 2020, and April 17, 2020. Demographics, medical and obstetrical history, and coronavirus disease 2019 encounter data were abstracted from medical records. RESULTS: A total of 46 pregnant patients with a severe acute respiratory syndrome coronavirus 2 infection were identified from hospital systems capturing 40% of births in Washington State. Nearly all pregnant individuals with a severe acute respiratory syndrome coronavirus 2 infection were symptomatic (93.5%, n¼43) and the majority were in their second or third trimester (43.5% [n¼20] and 50.0% [n¼23], respectively). Symptoms resolved in a median of 24 days (interquartile range, 13e37). Notably, 7 women were hospitalized (16%) including 1 admitted to the intensive care unit. A total of 6 cases (15%) were categorized as severe coronavirus disease 2019 with nearly all patients being either overweight or obese before pregnancy or with asthma or other comorbidities. Of the 8 deliveries that occurred during the study period, there was 1 preterm birth at 33 weeks' gestation to improve pulmonary status in a woman with class III obesity, and 1 stillbirth of unknown etiology. CONCLUSION: Severe coronavirus disease 2019 developed in approximately 15% of pregnant patients and occurred primarily in overweight or obese women with underlying conditions. Obesity and coronavirus disease 2019 may synergistically increase risk for a medically indicated preterm birth to improve maternal pulmonary status in late pregnancy. These findings support categorizing pregnant patients as a higher-risk group, particularly those with chronic comorbidities.

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

“…Overall, 487 (76.5%), 101 (15.9%), and 49 (7.7%) were diagnosed on admission as having, respectively, mild, severe, and critical COVID‐19 disease, according to clinical criteria defined by the Chinese Centre for Disease Control and Prevention 8 . Medical co‐morbidities were reported for 359 women 7,9–35 . The most common co‐morbidity was overweight or obesity (n=118, 32.9%), bronchial asthma (n=37, 10.3%), essential hypertension (n=21, 5.8%), and type 2 diabetes mellitus (n=10, 2.8%).…”

“…The incidence of adverse maternal outcomes was assessed for all 637 pregnant women (Table 1). The rate of intensive care unit (ICU) admission was 9.6% (n=61) (Table 1) and comprised 1 (1.6%) women in the first trimester, 5 (8.2%) women in the second trimester, and 55 (90.2%) women in the third trimester of pregnancy 7,15,18,24–31,42,44,48,53,59,63,66 . Among the 487 women admitted with mild COVID‐19, 9 (1.8%) deteriorated to severe or critical disease necessitating escalation of care to the ICU.…”

“…Of the 68 women who were initially asymptomatic at presentation, 2 (2.9%) later developed respiratory distress and were admitted into the ICU with critical disease. Invasive mechanical ventilation (IMV) was required for 51 (83.6%) of the 61 women in the ICU, 7,15,18,24–32,42,44,48,50,59,66 and 10 (16.4%) were managed with non‐invasive mechanical ventilation 7,50,53,63 ; 4 women ultimately required extra‐corporeal membrane oxygenation 34,47,49,55 . Among the 61 women admitted to the ICU, 10 women were reported to have died, 1 was still on extra‐corporeal membrane oxygenation, 4 remained intubated, and 46 had been successfully extubated.…”

Covid-19 in the second half of pregnancy: prevalence and clinical relevance

“…Interestingly, the rate of infected women observed in our study is very similar to the prevalence observed in a concomitant survey performed in our area and focusing on blood donors. Speci cally, Valenti et al women with Covid-19 necessitated hospitalization 7 . This rate resulted even higher (69%) in a Spanish cases series of 60 pregnant infected subjects 8 .…”

“…Albeit still limited, there is evidence that SARS-Cov-2 can cause life-threatening situations also in pregnancy, even if fatal cases seem rare [5][6][7][8][9] . Severe pneumonia occurs in 5-16% of women 5,8,9 and may require prompt pregnancy termination for improving respiratory assistance.…”