Pregnancy during a Pandemic: A Cohort Study Comparing Adverse Outcomes during and before the COVID-19 Pandemic

Abstract

OBJECTIVE: To evaluate how the COVID-19 pandemic may have negatively impacted birth outcomes in patients who tested negative for the SARS-CoV-2 virus. STUDY DESIGN: We conducted a retrospective cohort study using electronic health records of pregnant women admitted to a tertiary medical center in New York City, an epicenter of the pandemic. Women with a singleton gestation admitted for delivery from March 27-May 31, 2019 and March 27-May 31, 2020 were included. Women less than 18 years old, those with a positive SARS-CoV-2 PCR test on admission, fetal anomaly, or multiple gestation were excluded. Adverse pregnancy outcomes were compared between groups. Univariable and multivariable logistic regression was used to assess outcomes. The primary outcome was preterm birth. RESULTS: Women who delivered during the 2020 study interval had a significantly higher rate of hypertensive disorders of pregnancy (gestational hypertension or preeclampsia) (OR 1.40, 95% CI 1.05-1.85; p=0.02), postpartum hemorrhage (PPH) (OR 1.77, 95% CI 1.14-2.73; p=0.01), and preterm birth (OR 1.49, 95% CI 1.10-2.02; p=0.01). Gestational age at delivery was significantly lower in the 2020 cohort compared to the 2019 cohort (39.3 vs. 39.4 weeks, p=0.03). After adjusting for confounding variables, multivariate analysis confirmed a persistent increase in hypertensive disorders of pregnancy (OR=1.56, 95% CI 1.10-2.20, p=0.01), postpartum hemorrhage (OR=1.74, 95% CI: 1.06-2.86, p=0.03), and preterm birth (OR=1.72, 95% CI: 1.20-2.47, p=0.003) in patients who delivered in 2020 compared to the same period in 2019. Specifically, medically indicated preterm births increased during the pandemic (OR=3.17, 95% CI: 1.77-5.67, p<0.0001). CONCLUSION: Those who delivered during the COVID-19 pandemic study interval were more likely to experience hypertensive disorders of pregnancy, medically indicated preterm birth, and postpartum hemorrhage even in the absence of SARS-CoV2 infection.

Increased newborn NICU admission for evaluation of hypoxic-ischemic encephalopathy during COVID-19 pandemic in a public hospital

“…All these could have contributed to less monitoring and treatment of chronic diseases and pregnancy-related complications. Similar to our study, Rao et al ( 19 ) conducted a retrospective cohort study in a tertiary medical center in New York City, an epicenter of the pandemic. They found that women who delivered during the pandemic (27 March–31 May 2020) had a significantly higher rate of hypertensive disorders of pregnancy in maternal hypertension compared to women who delivered prior to the pandemic (27 March–31 May 2019) (OR = 1.05–1.85).…”

“…During the COVID-19 pandemic, many aspects of the healthcare system were disrupted, and pregnant women experienced fear, mental stress, and a worsening in socioeconomic disparities (17,18). Many studies have shown increased pregnancy complications, including maternal diabetes, hypertension, and obesity during the pandemic (19)(20)(21)(22)(23)(24)(25)(26). These complications are known risk factors for perinatal sentinel events and fetal and neonatal hypoxic-ischemic injury (27)(28)(29)(30).…”

Higher NICU admissions in infants born at ≥35 weeks gestational age during the COVID-19 pandemic

“…The increase in maternal morbidities has been reported both nationally and internationally. There has been an increase in maternal hypertension and diabetes reported in North American epicenters of the pandemic (14)(15)(16). A Chinese study showed that pregnant women who experienced lockdown had an increase in HbA1C in those with gestational diabetes and an increase in pregnancy-induced hypertension in normoglycemic women (17).…”