Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study

Abstract

Background To the best of our knowledge, no study has exhaustively evaluated the association between maternal morbidities and Coronavirus Disease 2019 (COVID-19) during the first wave of the pandemic in pregnant women. We investigated, in natural conceptions and assisted reproductive technique (ART) pregnancies, whether maternal morbidities were more frequent in pregnant women with COVID-19 diagnosis compared to pregnant women without COVID-19 diagnosis during the first wave of the COVID-19 pandemic. Methods and findings We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalizations for births ≥22 weeks of gestation in France from January to June 2020 using the French national hospitalization database (PMSI). Pregnant women with COVID-19 were identified if they had been recorded in the database using the ICD-10 (International Classification of Disease) code for presence of a hospitalization for COVID-19. A total of 244,645 births were included, of which 874 (0.36%) in the COVID-19 group. Maternal morbidities and adverse obstetrical outcomes among those with or without COVID-19 were analyzed with a multivariable logistic regression model adjusted on patient characteristics. Among pregnant women, older age (31.1 (±5.9) years old versus 30.5 (±5.4) years old, respectively, p < 0.001), obesity (0.7% versus 0.3%, respectively, p < 0.001), multiple pregnancy (0.7% versus 0.4%, respectively, p < 0.001), and history of hypertension (0.9% versus 0.3%, respectively, p < 0.001) were more frequent with COVID-19 diagnosis. Active smoking (0.2% versus 0.4%, respectively, p < 0.001) and primiparity (0.3% versus 0.4%, respectively, p < 0.03) were less frequent with COVID-19 diagnosis. Frequency of ART conception was not different between those with and without COVID-19 diagnosis (p = 0.28). When compared to the non-COVID-19 group, women in the COVID-19 group had a higher frequency of admission to ICU (5.9% versus 0.1%, p < 0.001), mortality (0.2% versus 0.005%, p < 0.001), preeclampsia/eclampsia (4.8% versus 2.2%, p < 0.001), gestational hypertension (2.3% versus 1.3%, p < 0.03), postpartum hemorrhage (10.0% versus 5.7%, p < 0.001), preterm birth at <37 weeks of gestation (16.7% versus 7.1%, p < 0.001), <32 weeks of gestation (2.2% versus 0.8%, p < 0.001), <28 weeks of gestation (2.4% versus 0.8%, p < 0.001), induced preterm birth (5.4% versus 1.4%, p < 0.001), spontaneous preterm birth (11.3% versus 5.7%, p < 0.001), fetal distress (33.0% versus 26.0%, p < 0.001), and cesarean section (33.0% versus 20.2%, p < 0.001). Rates of pregnancy terminations ≥22 weeks of gestation, stillbirths, gestational diabetes, placenta praevia, and placenta abruption were not significantly different between the COVID-19 and non-COVID-19 groups. The number of venous thromboembolic events was too low to perform statistical analysis. A limitation of this study relies in the possibility that asymptomatic infected women were not systematically detected. Conclusions We observed an increased frequency of pregnant women with maternal morbidities and diagnosis of COVID-19 compared to pregnant women without COVID-19. It appears essential to be aware of this, notably in populations at known risk of developing a more severe form of infection or obstetrical morbidities and in order for obstetrical units to better inform pregnant women and provide the best care. Although causality cannot be determined from these associations, these results may be in line with recent recommendations in favor of vaccination for pregnant women.

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

“…Three concerns regarding pregnant women have arisen as a result of the present COVID-19 outbreak: (1) whether COVID-19 represents a risk for pregnant women, (2) whether pregnant women are more affected by COVID-19 than nonpregnant women, and (3) whether there is a risk of vertical mother-to-child transmission [ 34 ]. Therefore, we conducted this study to explore whether pregnancy increases the risk of certain adverse outcomes in COVID-19 compared to non-pregnant women with COVID-19.…”

Secondary Analysis of Maternal Characteristics and Pregnancy Outcomes of COVID-19 Positive Pregnant Women in Sri Lanka using National COVID-19 Positive Pregnant Women Surveillance

“…Therefore, deliveries of these women might not have occurred by 31st of October. There could be cases where the COVID-19 positive pregnant [10]. Similarly, increased prevalence of pre-existing DM and HT among the COVID-19 positive pregnant women was observed compared to the national data of pregnant women.…”

Critical Care Management of a Severe Acute Respiratory Distress Syndrome COVID-19 Patient With Control Cesarean Section

“…Proning provides an augmented ventilation-perfusion ratio while decreasing the compression of the posterior and medial lung, causing a decrease in hypoxic vasoconstriction, an improvement in cardiac output, and recruitment of more alveolar units. There is a lack of randomized control trials, but the complications of standard ARDS patients included barotrauma, bleeding, transient hypotension, and transient hypoxia which could all be detrimental to the baby [ 8 ]. The need for delivery should be coordinated with a neonatologist and OB-GYN.…”

“…The positive pressure of ventilation and severe hypoxemia with low arterial oxygen can be deleterious to a baby, making the womb a non-hospitable place for the unborn baby. Furthermore, in order to treat hypoxemia, the use of positive end-expiratory pressure (PEEP) and mechanical ventilation in these patients can also cause increased intrathoracic pressure, leading to decreased cardiac output and hypotension [ 8 , 9 ]. The use of vasoactive agents, such as norepinephrine, vasopressin, and large volumes of (IV) fluids can affect the cardiorespiratory system of the unborn baby.…”