Pregnancy worsens the morbidity of COVID-19 and this effect becomes more prominent as pregnancy advances

Abstract

Objective: To investigate pregnancy outcomes and compare the clinical characteristics of coronavirus 2019 (COVID-19) disease in pregnant and agematched non-pregnant women.

Materials and methods: Hospital records of four tertiary care centers were reviewed retrospectively. The subjects comprised 188 pregnant patients and 799 non-pregnant women who were admitted to these hospitals.

Results: Pregnancy significantly affected the clinical severity of COVID-19 and this effect was more prominent in pregnant women at >20 weeks gestation (p<0.001). Rates of oxygen support (10.1% vs 4.8%; p≤0.001), intensive care unit admission (3.2% vs 0.6%; p=0.009), presence of fever (12.8% vs 4.4%; p<0.001), tachypnea (7.0% vs 2.4%; p=0.003) and tachycardia (16.0% vs 1.9%; p<0.001) were significantly more frequent in pregnant women compared with non-pregnant women. Pregnancy was strongly associated with the need for oxygen support [relative risk (RR), 2.125; 95% confidence interval (CI): 1.25-3.60] and admission to the intensive care unit (RR, 5.1; 95% CI: 1.57-16.53) compared with non-pregnant women. Some 14.4% of the pregnant women had co-morbidities. Sixty of the 188 pregnant women (31.9%) delivered during the Severe Acute Respiratory syndrome coronavirus-2 infection, 11 (18.3%) had vaginal deliveries and 49 (81.7%) were by cesarean section. Of these 60 deliveries, 40 (66.7%) were <37 weeks gestation.

Conclusion: Pregnancy worsens the morbidity of COVID-19 and this effect seems to increase as the pregnancy advances, but not the mortality rate.

Keywords: COVID-19; SARS-CoV-2; intensive care unit admission; morbidity; pregnancy; preterm birth.