Maternal and Neonatal Outcomes of Pregnant Women with Clinically Confirmed COVID-19 Admitted at the Philippine General Hospital

Abstract

Objectives. The effect of COVID-19 infection in pregnant women and her neonate is not well-understood, with no clear evidence for vertical transmission. This study aims to determine the maternal and neonatal clinical characteristics and the dyad’s outcomes among those infected with COVID-19 infection.
 Methods. An ambispective cross-sectional study involving pregnant women with confirmed COVID-19 infection was conducted at the Philippine General Hospital from April to August 2020. Two hundred nine obstetric patients were included, 14 of whom consented to specimen collection to determine vertical transmission.
 Results. The majority of pregnant women with COVID-19 infection and their neonates had good outcomes. Labor, delivery, and the immediate postpartum course were generally uneventful. The all-cause maternal morbidity rate was high at 75.6 per 100 cases during the five-month study period. COVID-19 related morbidities included the development of Guillain-Barré Syndrome. The in-hospital all-cause maternal mortality rate was 1.91 per 100 cases. The causes of maternal death were acute respiratory failure, septic shock, and congenital heart disease (atrial septal defect with Eisenmengerization). The in-hospital, all-cause neonatal mortality rate was 1.04 per 100 neonates of cases. The lone mother and infant deaths were in a postmortem rt-PCR swab negative mother with an rt-PCR swab positive live neonate who eventually succumbed after nine days of life. All 14 dyads with collected specimens that included amniotic fluid, placental tissue, umbilical cord, and neonate nasopharyngeal swab tested negative for SARS-CoV-2 rt-PCR.
 Conclusion. The prognosis for COVID-19 infected pregnant patients was generally good, with most of the patients discharged improved. Almost all of the neonates born to COVID-19-infected mothers were stable-term infants. There was no evidence for vertical transmission, as shown by negative rt-PCR results for all the additional specimens obtained.
 In general, the prognosis for COVID-19 infected dyads was good. The majority of the mothers were discharged well with their term infants. All possible maternal sources of COVID-19 infection to the neonate tested negative. This study provided no evidence for vertical transmission.

Clinical Outcomes of COVID-19 Infection in Pregnant and Nonpregnant Women: Results from The Philippine CORONA Study

“…This finding may reflect the younger age and lower prevalence of comorbidities among pregnant women in our study. Previous reports in the Philippines also showed lower comorbidities in pregnant patients infected with COVID-19 [ 2 , 4 ]. Although pregnant women had a significantly more extended hospital stay, they had shorter ICU admission, shorter ventilator dependence, resolved or improved neurologic symptoms at hospital discharge, and had a lower risk of mortality.…”

“…Based on a local study, about 35% of COVID-19-infected pregnant women were symptomatic [ 2 ]. Similar to our result, they commonly present with fever and cough [ 2 , 3 , 8 , 19 ].…”

“…Based on a local study, about 35% of COVID-19-infected pregnant women were symptomatic [ 2 ]. Similar to our result, they commonly present with fever and cough [ 2 , 3 , 8 , 19 ]. Compared with nonpregnant women, pregnant women more frequently present with colds and anosmia, while the former mostly present with cough, dyspnea, chills, fatigue, and headache [ 7 ].…”

“…Pre-existing comorbidity can increase the risk of pregnant women acquiring an infection that requires hospitalization [ 9 ]. Interestingly, a local study reported that nearly 50% of pregnant patients with COVID-19 had no comorbid condition [ 2 ]. Most of their included patients were probably under 35 years of age.…”

“…Earlier reports in the Philippines indicated that several pregnant COVID-19 patients were asymptomatic, ranging from 22 to 42% of individuals [ 2 , 3 , 4 ]. Previous studies have also suggested that pregnant women with COVID-19 have a favorable clinical course compared with the nonpregnant population [ 2 , 5 , 6 , 7 , 8 , 9 , 10 ]; however, pre-existing diseases may increase the probability of hospitalization [ 9 ]. An increased risk of acquiring severe disease was found in pregnant women with comorbidities, including those who presented with fever, cough, headache, dyspnea, and diarrhea [ 3 ].…”