COVID-19 outcomes among pregnant and nonpregnant women at reproductive age in Egypt

Abstract

Background To describe demographic, clinical and epidemiological characteristics of pregnant and nonpregnant women with confirmed COVID-19 at reproductive age and determine risk factors of COVID-19 severe outcomes during pregnancy. Methods A retrospective study for females aged 18–49 with confirmed COVID-19 by RT-PCR in Egypt, February–July 2020. Data were obtained from Egypt National Surveillance, bivariate and multivariate analysis for demographic and clinical characteristics and outcomes of COVID-19 between pregnant and nonpregnant women including ICU admission, need for ventilator and death was performed. Results A total of 23 095 females were identified, with mean (SD) age of 35.1 (8.1) year. Of those, 408 (1.8%) were pregnant, with mean (SD) age of 29.3 (8.1) years. Compared to nonpregnant, pregnant patients were more likely to be admitted to hospital (OR = 1.7 CI = 1.4–2.1), ICU (OR = 2.4, CI = 1.3–4.3), need ventilator (OR = 3.9, CI = 2.1–7.4) and have severe outcome (OR = 3.0, CI = 1.9–4.7). Factors associated with severe outcome included: pregnancy, age > 30 years, underlying medical conditions, and living in rural areas. Conclusion Pregnant women with COVID-19 are at higher risk of severe symptoms and outcome including ICU admission, requiring ventilator and death. To reduce risk of severe outcome, counseling about for seeking medical care and health education about COVID-19 preventive measures should be performed.

The association between pregnancy and COVID-19: A systematic review and meta-analysis

“…This previous systematic review and meta-analysis [ 37 ] also showed that pregnant women with COVID-19 are less likely to have those symptoms than non-pregnant women of reproductive age with COVID-19. The lower incidence of fever in our study may be related to the different definitions and measurements of fever between the included studies; for example, BahaaEldin's study [ 26 ] only provided data for body temperature > 38 °C, which this study directly adopted as the data for fever.…”

“…We included 8 published studies [ [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ] with 859,278 COVID-19 female patients, of which 37,578 (4.37%) cases were pregnant patients. Most study designs are cohort studies or case-control studies.…”

“…For death, we extracted RRs or ORs from 6 original studies [ 26 , 27 , 29 , 30 , 32 , 33 ]. Three studies suggest that pregnancy increases the risk of death, yet one study suggests that pregnancy is a protective factor against death.…”

“…In total, 6 studies [ 26 , 28 , 29 , [31] , [32] , [33] ] provided data on ICU admission. All but one of the studies showed that pregnancy increased the risk of ICU admission.…”

“…Based on the extracted RR or OR from 4 studies [ 26 , 29 , 31 , 33 ] to calculate the pooled RR of ventilation (RR = 2.13, 95% CI = 1.06–4.28, I 2 = 92.7%, REM), the results showed that pregnancy was associated with a statistically significant increased risk of ventilation in COVID-19 patients. The result is shown in Fig.…”