Maternal outcomes and risk factors for COVID-19 severity among pregnant women

Abstract

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.

The Incidence, Severity, and Management of COVID-19 in Critically Ill Pregnant Individuals

“…11 A large international study also demonstrated that the presence of diabetes, hypertension and pulmonary disease were risk factors for COVID-19 infection during pregnancy. 12 In summary, the incidence of COVID-19 does not appear to be higher in pregnancy.…”

“…An increased rate of preterm birth, low birth weight, pre-eclampsia, and Cesarean delivery has been described with COVID-19. 6,8,12,18 Among pregnant individuals with COVID-19 who delivered in Canada, 97% of births were live births, 63% were vaginal deliveries, and 37% were Cesarean sections driven by obstetrical, fetal, or medical indications. 6 The rate of preterm birth was 12.3% in pregnant individuals with COVID-19, which is higher than the pre-pandemic period (8.3% baseline rate).…”

Tocilizumab for coronavirus disease 2019 in pregnancy and lactation: a narrative review

“…Although our understanding is still evolving, available data strongly suggests pregnant people with COVID-19 infection experience a higher severity of illness and increased rates of complications compared to age-matched non-pregnant patients; neonatal morbidities are also increased. ( 2 , 3 , 4 , 5 , 6 , 7 , 8 ) Effective prevention and treatment strategies are therefore critically important to improve maternal and neonatal outcomes but, regressive policies excluding pregnant people from participating in biomedical research persist. ( 9 , 10 ) Clinicians and pregnant people are left with the difficult task of deciding whether potential benefits of a treatment outweigh potential harms to the fetus based on very little information.…”

“…( 2 , 3 , 4 , 5 , 6 ) In addition, COVID-19 has been associated with increased preterm birth and neonatal morbidities. ( 2 , 3 , 5 , 6 , 7 , 8 ).…”

SARS-CoV-2 in Pregnant Women: Consequences of Vertical Transmission

“…For instance, among infected women of the reproductive age range (ages 12-51), it was found that pregnant women in this range were more likely to be hospitalized and admitted into the Intensive Care Unit (ICU) as compared to non-pregnant women in the same range, but both non-pregnant and pregnant women had a similar chance for death ( Ellington et al., 2020 ; Zambrano et al., 2020 ). Since pregnant women are considered to be vulnerable to SARS-CoV-2 infection, it is essential to understand if the virus could infect the developing fetus ( Panagiotakopoulos et al., 2020 ; Brandt and Fell, 2021 ; Vivanti et al., 2020a ; Vouga et al., 2021 ).…”