The Relationship between Status at Presentation and Outcomes among Pregnant Women with COVID-19

Abstract

Objective This study was aimed to compare maternal and pregnancy outcomes of symptomatic and asymptomatic pregnant women with novel coronavirus disease 2019 (COVID-19). Study Design This is a retrospective cohort study of pregnant women with COVID-19. Pregnant women were divided into two groups based on status at admission, symptomatic or asymptomatic. All testing was done by nasopharyngeal swab using polymerase chain reaction (PCR) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Initially, nasopharyngeal testing was performed only on women with a positive screen (symptoms or exposure) but subsequently, testing was universally performed on all women admitted to labor and delivery. Chi-square and Wilcoxon's rank-sum tests were used to compare outcomes between groups. Results Eighty-one patients were tested because of a positive screen (symptoms [n = 60] or exposure only [n = 21]) and 75 patients were universally tested (all asymptomatic). In total, there were 46 symptomatic women and 22 asymptomatic women (tested based on exposure only [n = 12] or as part of universal screening [n = 10]) with confirmed COVID-19. Of symptomatic women (n = 46), 27.3% had preterm delivery and 26.1% needed respiratory support while none of the asymptomatic women (n = 22) had preterm delivery or need of respiratory support (p = 0.007 and 0.01, respectively). Conclusion Pregnant women who presented with COVID19-related symptoms and subsequently tested positive for COVID-19 have a higher rate of preterm delivery and need for respiratory support than asymptomatic pregnant women. It is important to be particularly rigorous in caring for COVID-19 infected pregnant women who present with symptoms. Key Points

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

“…Miscarriage or termination of pregnancy was reported in six studies 32–34,53,54,63 . In total, there were seven miscarriages five in the first trimester, and two in the second trimester.…”

“…Seven (1.9%) women were aged 40 years or older. Presenting symptoms were reported in 55 studies, comprising 515 pregnant women 4,5,7,11–19,21–30,32–57 . Of these, the most common symptoms at presentation were fever (n=273, 53.0%), cough (n=224, 43.5%), myalgia/malaise (n=79, 15.3%), dyspnea (n=64, 12.4%), diarrhea (n=18, 3.5%), and sore throat (n=18, 3.5%), regardless of gestational age.…”

“…In addition, six women experienced postpartum hemorrhage (estimated blood loss >1000 mL), all of whom had undergone cesarean delivery. Three of these women had severe or critical COVID‐19: one had developed consumptive coagulopathy requiring treatment with fibrinogen concentrate, whereas the other two had mild COVID‐19 disease 18,20,32 …”

Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: A living systematic review and meta-analysis

“…The remaining studies, in hospital settings, included adult patients only (15 studies, n = 3,228) [27,39,45,52,53,56,57,64,80,83,89,92,103,107,114], children only (10 studies, n = 285) [40][41][42]59,84,87,98,99,104,106], or adults and children (10 studies, n = 1,518) [54,67,77,79,86,88,96,102,109,112] (Table 1, Fig 1). The types of hospital and clinical severity of patients differed, including settings in which anyone with SARS-CoV-2 infection was admitted for isolation and traditional hospitals.…”

Perinatal COVID-19 Infection Prevention: Infographics for Patients and Providers

“…[3][4][5] SARS-CoV-2 infection in pregnancy has other consequences, even if the mother remains asymptomatic or have mild disease. 6,7 Pregnant women who test positive for SARS-CoV-2 require isolation and special care during labor, vaginal delivery, or cesarean. [8][9][10] Visitors or support persons may not be allowed, and the mother may not be able to visit the nursery if the newborn requires additional care.…”