Pregnancy and postpartum outcomes in a universally tested population for SARS‐CoV‐2 in New York City: a prospective cohort study

Abstract

Objective To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). Design Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. Setting Three New York City hospitals. Population Pregnant women >20 weeks of gestation admitted for delivery. Methods Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. Main outcome measures Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. Results Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%, P < 0.001). Conclusion Among pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery.

Association of SARS-CoV-2 Test Status and Pregnancy Outcomes

“…3 The absence of an increased prevalence of preterm birth is concordant with results of 2 previous studies using comparators. 4,5 The lack of difference in Apgar scores and birth weight for gestational age between groups is similar to that in a US study. 4 a Direct matching on multiple births and on a propensity score including maternal age, parity, early-pregnancy body mass index, educational level, country of birth, smoking status, living with partner, and prepregnancy comorbidity (yes/no).…”

“…4,5 The lack of difference in Apgar scores and birth weight for gestational age between groups is similar to that in a US study. 4 a Direct matching on multiple births and on a propensity score including maternal age, parity, early-pregnancy body mass index, educational level, country of birth, smoking status, living with partner, and prepregnancy comorbidity (yes/no). b Variables in the regression models were age (continuous), body mass index (<30/Ն30), country of birth (Nordic/non-Nordic), parity (nulliparous/parous), living with partner (yes/no), and prepregnancy comorbidity.…”

Impact of SARS-CoV-2 antibodies at delivery in women, partners and newborns

“…3 The authors found a significantly higher incidence of cesarean sections, postpartum complications and placental pathology among women with COVID-19 compared to women without the disease. 3 To date only a few studies have focused on serological testing for SARS-CoV-2 in pregnant women. [4][5][6] A recent study from Philadelphia, USA, performed serological testing on 1,293 women admitted for delivery and found a seroprevalence of 6.2%.…”

“…3 Of these 78.6% were asymptomatic. 3 The authors found a significantly higher incidence of cesarean sections, postpartum complications and placental pathology among women with COVID-19 compared to women without the disease. 3 To date only a few studies have focused on serological testing for SARS-CoV-2 in pregnant women.…”

“…1 Currently, data from studies investigating the impact of COVID-19 in pregnancy have mainly been based on detection of viral RNA by polymerase chain reaction (PCR) analysis. 2,3 A recent study of 675 women admitted for delivery in New York City found a prevalence of COVID-19 of 10.4%. 3 Of these 78.6% were asymptomatic.…”