Retrospective Description of Pregnant Women Infected with Severe Acute Respiratory Syndrome Coronavirus 2, France

Abstract

R ecent literature from China, Italy, and the United States suggests that pregnant women are not at higher risk for severe forms of coronavirus disease (COVID-19) from infection with severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), contrary to what has been reported with SARS and MERS (1-3). Nevertheless, 3%-35% of infected pregnant women were hospitalized in intensive care units (ICUs) (2,4-7) and respiratory and hematology anomalies were described, just as in the nonpregnant infected population (8). In the third trimester, and especially after 37 weeks' gestation, the fetal prognosis is driven by maternal clinical tolerance and by whether a cesarean delivery is required. Few cases of vertical transmission have been published (6-9), and no data are available on the risk factors for such transmission. However, between 24 and 32 weeks' gestation, the risk for premature birth and the need to reduce its effects on neonatal outcome by giving steroids and magnesium sulfate to the mother complicate decision-making. Little published data are available on the management of SARS-CoV-2-infected pregnant women (10). We describe the experience of 4 tertiary referral obstetric units in managing such cases in the Paris metropolitan area of France. Materials and Methods Study Design and Population We conducted a retrospective multicenter review of the medical records of all pregnant women with SARS-CoV-2 from March 12-April 13, 2020, in 4 tertiary referral obstetric units in the Paris metropolitan area. Hospitals included in the study were Antoine Béclère, Clamart; Bicêtre Hospital, Le Kremlin Bicêtre; Louis-Mourier, Colombes; and Centre Hospitalier Sud Francilien, Evry. All women in the second and third trimester of pregnancy (>14 weeks' gestation) had real-time reverse transcription PCR (RT-PCR) testing of respiratory tract samples to detect

Are clinical outcomes worse for pregnant women at ≥20 weeks’ gestation infected with coronavirus disease 2019? A multicenter case-control study with propensity score matching

“…However, the participating centers involved did not drastically alter their management of patients with COVID-19 on the basis of pregnancy, except in cases of deterioration during the third trimester, when emergency delivery was sometimes needed to alleviate the additional physiological demands of pregnancy (data not indicated in this study). Based on this study and those of some other groups, 1 , 2 , 3 , 4 , 5 , 6 we advise clinicians to exercise prudence when planning the management of pregnant women diagnosed with COVID-19, particularly in the latter half of the pregnancy, when maternal risk of clinical decompensation and complications may be higher.…”

“…Early reports focused solely on the fetal risks; however, the emphasis has correctly shifted toward maternal health. 2 , 3 , 4 , 5 , 6 A recent study reported a hospitalization rate of 52%, including a rate of 10% in intensive care unit (ICU) admission. 5 Nevertheless, the available literature is somewhat conflicting with some studies suggesting that pregnancy is not associated with markers of disease severity and others reporting worse outcomes.…”

“… 2 , 3 , 4 , 5 , 6 A recent study reported a hospitalization rate of 52%, including a rate of 10% in intensive care unit (ICU) admission. 5 Nevertheless, the available literature is somewhat conflicting with some studies suggesting that pregnancy is not associated with markers of disease severity and others reporting worse outcomes. This contradiction implies the need for larger and more methodologically robust matched case-control studies to clarify the association between pregnancy and the coronavirus disease 2019 (COVID-19).…”

Maternal and neonatal characteristics and outcomes among COVID-19 infected women: An updated systematic review and meta-analysis

“…In addition, 2 studies were excluded due to duplicity of data reporting. Out of 27 studies [ [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] ], 16 studies were from China (14 were from Hubei province and 2 from Guangzhou) and 4 studies was from USA [ [44] , [45] , [46] , [47] ], 2 from France [ 48 , 49 ], 2 from Italy [ 50 , 51 ], 1 from UK [ 52 ], 1 from Spain [ 53 ], and 1 from Iran [ 54 ]. Of 27 studies, 4 studies (n = 233) also included a control group [ [38] , [39] , [40] , [41] ].…”

Clinical manifestations and perinatal outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

“…Thereafter, 169 articles were excluded for the following reasons: reviews and expert opinions (n = 55); case reports with less than 10 cases (n = 52); irrelevant studies (n = 17); studies without confirmation of COVID-19 by polymerase chain reaction (PCR) tests (n = 9); studies only including the infants born to mothers without confirmed COVID-19 (n = 7); and overlapping studies (n = 29). Hence, eleven studies on 9032 pregnant women with COVID-19 and 338 neonates were ultimately included for meta-analysis [17][18][19][20][21][22][23][24][25][26][27] . The main characteristics of the included studies are listed in Table 1.…”