Coronavirus disease 2019 pregnancy outcomes in a racially and ethnically diverse population

Abstract

Background: Older age and medical comorbidities are identified risk factors for developing severe coronavirus disease 2019. However, there are limited data on risk stratification, clinical and laboratory course, and optimal management of coronavirus disease 2019 in pregnancy.

Objective: Our study aimed to describe the clinical course of coronavirus disease 2019, effect of comorbidities on disease severity, laboratory trends, and pregnancy outcomes of symptomatic and asymptomatic severe acute respiratory syndrome coronavirus 2-positive pregnant women.

Study design: This is a case series of pregnant and postpartum women who received positive test results for severe acute respiratory syndrome coronavirus 2 between March 3, 2020, and May 11, 2020, within 3 hospitals of the Yale New Haven Health delivery network. Charts were reviewed for basic sociodemographic and prepregnancy characteristics, coronavirus disease 2019 course, laboratory values, and pregnancy outcomes.

Results: Of the 1567 tested pregnant and postpartum women between March 3, 2020, and May 11, 2020, 9% (n=141) had a positive severe acute respiratory syndrome coronavirus 2 result. Hispanic women were overrepresented in the severe acute respiratory syndrome coronavirus 2-positive group (n=61; 43.8%). In addition, Hispanic ethnicity was associated with a higher rate of moderate and severe diseases than non-Hispanic (18% [11/61] vs 3.8% [3/78], respectively; odds ratio, 5.5; 95% confidence interval, 1.46-20.7; P=.01). Of note, 44 women (31.2%) were asymptomatic, 37 of whom (26.2%) were diagnosed on universal screening upon admission for delivery. Moreover, 59% (n=83) were diagnosed before delivery, 36% (n=51) upon presentation for childbirth, and 5% (n=7) after delivery. Severe disease was diagnosed in 6 cases (4.3%), and there was 1 maternal death. Obese women were more likely to develop moderate and severe diseases than nonobese women (16.4% [9/55] vs 3.8% [3/79]; odds ratio, 4.96; 95% confidence interval, 1.28-19.25; P=.02). Hypertensive disorders of pregnancy were diagnosed in 22.3% of women (17/77) who delivered after 20 weeks' gestation. Higher levels of C-reactive protein during antepartum coronavirus disease 2019-related admission were more common in women with worse clinical course; however, this association did not reach statistical significance.

Conclusion: Coronavirus disease 2019 in pregnancy may result in severe disease and death. Hispanic women were more likely to receive a positive test result for severe acute respiratory syndrome 2 than other ethnic groups. Obesity and Hispanic ethnicity represent risk factors for moderate and severe diseases.

Keywords: Hispanic ethnicity; coronavirus; coronavirus disease 2019; pregnancy; severe acute respiratory syndrome coronavirus 2.

Figure 1

Timing of diagnosis, clinical course, and pregnancy outcomes in COVID-19–positive women C/S, cesarean delivery; COVID-19, coronavirus disease 2019; D&E, dilation and evacuation; HELLP, hemolysis, elevated liver enzymes, and low platelet count; ICU, intensive care unit; SAB, spontaneous abortion; TAB, therapeutic abortion. Grechukhina et al. A series of 141 cases of COVID-19 in pregnancy. AJOG MFM 2020.

Figure 2

Symptom frequency among different groups of symptomatic COVID-19–positive patients A, Overall symptom frequency in the symptomatic group. B, Symptom frequency in symptomatic group stratified by the severity of COVID-19 disease. The P values were based on Fisher exact test of association between the 3-level severity and dichotomous symptoms. Symptoms with P<.05 were marked with an asterisk. COVID-19, coronavirus disease 2019; SOB, shortness of breath. Grechukhina et al. A series of 141 cases of COVID-19 in pregnancy. AJOG MFM 2020.

Figure 3

Laboratory trends in admitted symptomatic and asymptomatic COVID-19-positive women A, D-dimer trends in asymptomatic and symptomatic patients with COVID-19 during delivery encounter. B, D-dimer trends in COVID-19–positive patients admitted before delivery (for COVID-19 and non–COVID-19 indications), who were discharged undelivered. C, CRP trends in asymptomatic and symptomatic patients with COVID-19 during delivery encounter. Marked lines indicate cesarean delivery. D, CRP trends in COVID-19–positive patients admitted before delivery (for COVID-19 and non–COVID-19 indications), who were discharged undelivered. COVID-19, coronavirus disease 2019; CRP, C-reactive protein; D&E, dilation and evacuation; ICU, intensive care unit; PNA, pneumonia. Grechukhina et al. A series of 141 cases of COVID-19 in pregnancy. AJOG MFM 2020.