SARS‐CoV‐2 infection in pregnancy during the first wave of COVID‐19 in the Netherlands: a prospective nationwide population‐based cohort study (NethOSS)

Abstract

Objective To describe characteristics, risk factors and maternal, obstetric and neonatal outcomes of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Design Multi‐centre prospective population‐based cohort study. Setting Nationwide study in the Netherlands. Population Pregnant women with confirmed SARS‐CoV‐2 infection admitted to hospital or in home‐isolation: 1 March 2020 to 31 August 2020. Methods Pregnant women with positive polymerase chain reaction or antibody tests were registered using the Netherlands Obstetrics Surveillance System (NethOSS). (Selective) testing occurred according to national guidelines. Data from the national birth registry (pregnant pre‐coronavirus disease 2019 [COVID‐19] cohort) and an age‐matched cohort of COVID‐19‐positive women (National Institute for Public Health and the Environment; fertile age COVID‐19 cohort) were used as reference. Main outcome measures Incidence of SARS‐CoV‐2 infection in pregnant women. Maternal, obstetric and neonatal outcomes including hospital and intensive care admission. Results Of 376 registered pregnant women with confirmed SARS‐CoV‐2 infection, 20% (74/376) were admitted to hospital, of whom 84% (62/74) were due to SARS‐CoV‐2; 10% (6/62) were admitted to intensive care and 15% (9/62) to obstetric high‐care units. Risk factors for admission were non‐European country of origin (odds ratio [OR] 1.73, 95% CI 1.01–2.96) and being overweight/obese (OR 1.86, 95% CI 1.51–3.20). No maternal or perinatal deaths occurred. Caesarean section after labour‐onset was increased (OR 1.58, 95% CI 1.09–2.28). Hospital and intensive care admission were higher compared with the fertile age COVID‐19 cohort (OR 6.75, 95% CI 5.18–8.81 and OR 2.52, 95% CI 1.11–5.77, respectively). Conclusions Non‐European country of origin and being overweight/obese are risk factors for severe course of SARS‐CoV‐2 infection in pregnancy, risk of caesarean section and hospital and intensive care unit admission are increased. Tweetable abstract Pregnant women with SARS‐CoV‐2 in the Netherlands show increased hospital/ICU admission and caesarean section.

Diagnosis and management of covid-19 in pregnancy

“…Similar changes in severity have been reported in the UK, Italy, and the Netherlands with changing variant type 22122. In the period during which the delta variant predominated in the UK, 16% of symptomatic pregnant women admitted to hospital were admitted to an intensive care unit,2 and one in five of all patients receiving ECMO were women who were pregnant or post partum 23.…”

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

“…We included 8 published studies [ [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ] with 859,278 COVID-19 female patients, of which 37,578 (4.37%) cases were pregnant patients. Most study designs are cohort studies or case-control studies.…”

“…In total, 6 studies [ 26 , 28 , 29 , [31] , [32] , [33] ] provided data on ICU admission. All but one of the studies showed that pregnancy increased the risk of ICU admission.…”

Are in‐hospital COVID‐19‐related mortality and morbidity in pregnancy associated with gestational age?

“…These findings are not in line with those of the present study, and the discrepancy may be attributed to the fact that our analysis considers a number of variables that were not considered elsewhere. These include intervention 26 , 32 , 33 , 34 and type of healthcare provider 25 , 26 , 32 , 33 , 35 . These variables were found to be significantly different between trimester groups in our study, suggesting that studies omitting these variables may be prone to confounding.…”