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[Preprint]. 2020 Oct 14:2020.08.17.20161760.
doi: 10.1101/2020.08.17.20161760.

SARS-CoV-2 (COVID-19) infection in pregnant women: characterization of symptoms and syndromes predictive of disease and severity through real-time, remote participatory epidemiology

Erika Molteni  1 , Christina M Astley  2 , Wenjie Ma  3 , Carole H Sudre  1 , Laura A Magee  4 , Benjamin Murray  1 , Tove Fall  5 , Maria F Gomez  6 , Neli Tsereteli  6 , Paul W Franks  6 , John S Brownstein  2 , Richard Davies  7 , Jonathan Wolf  7 , Tim D Spector  8 , Sebastien Ourselin  1 , Claire J Steves  8 , Andrew T Chan  3 , Marc Modat  1
Affiliations

SARS-CoV-2 (COVID-19) infection in pregnant women: characterization of symptoms and syndromes predictive of disease and severity through real-time, remote participatory epidemiology

Erika Molteni et al. medRxiv. .

Update in

Abstract

Objective: To test whether pregnant and non-pregnant women differ in COVID-19 symptom profile and severity. To extend previous investigations on hospitalized pregnant women to those who did not require hospitalization.

Design: Observational study prospectively collecting longitudinal (smartphone application interface) and cross-sectional (web-based survey) data.

Setting: Community-based self-participatory citizen surveillance in the United Kingdom, Sweden and the United States of America.

Population: Two female community-based cohorts aged 18-44 years. The discovery cohort was drawn from 1,170,315 UK, Sweden and USA women (79 pregnant tested positive) who self-reported status and symptoms longitudinally via smartphone. The replication cohort included 1,344,966 USA women (134 pregnant tested positive) who provided cross-sectional self-reports.

Methods: Pregnant and non-pregnant were compared for frequencies of symptoms and events, including SARS-CoV-2 testing and hospitalization rates. Multivariable regression was used to investigate symptoms severity and comorbidity effects.

Results: Pregnant and non-pregnant women positive for SARS-CoV-2 infection were not different in syndromic severity. Pregnant were more likely to have received testing than non-pregnant, despite reporting fewer symptoms. Pre-existing lung disease was most closely associated with the syndromic severity in pregnant hospitalized women. Heart and kidney diseases and diabetes increased risk. The most frequent symptoms among all non-hospitalized women were anosmia [63% pregnant, 92% non-pregnant] and headache [72%, 62%]. Cardiopulmonary symptoms, including persistent cough [80%] and chest pain [73%], were more frequent among pregnant women who were hospitalized.

Conclusions: Symptom characteristics and severity were comparable among pregnant and non-pregnant women, except for gastrointestinal symptoms. Consistent with observations in non-pregnant populations, lung disease and diabetes were associated with increased risk of more severe SARS-CoV-2 infection during pregnancy.

Keywords: SARS-CoV-2 risk factors; SARS-CoV-2 severity; anosmia; citizen science; community SARS-CoV-2 symptoms; digital health; pregnancy; syndromic surveillance.

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Conflict of interest statement

Declaration of interest EM, CMA, WM, JB, MFG, MM have no conflict of interest. ATC previously served as an investigator on a clinical trial of diet and lifestyle using a separate mobile application that was supported by Zoe Global Ltd.

Figures

Figure 1.
Figure 1.
Receiver Operating Characteristics curve showing validation of the imputation of SARSCoV-2 test status using the mapped symptom score probability in the replication cohort. Area under the curve is 74%.
Figure 2.
Figure 2.
Comparison of symptoms presentation in the discovery (DC) and replication (RC) cohorts. Results refer to non-pregnant (orange) and pregnant (blue) women tested positive and suspected positive for SARS-CoV-2 and who required hospitalization (in DC, darker shade) or were seen at the hospital (RC, lighter shade). Results are reported as age-standardized percentage of women reporting each symptom in each sub-cohort.
Figure 3.
Figure 3.
Symptom profile of hospitalized and non-hospitalized pregnant and non-pregnant women positive and suspected positive to SARS-CoV-2 in the discovery cohort. Results are reported in percentage of women reporting each symptom in each group.
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