Maternal outcomes and risk factors for COVID-19 severity among pregnant women

Abstract

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.

Figure 1

Flow chart. The COVI-Preg international registry was launched in March 2020. To date, 120 centers from 16 countries have contributed patients (supplementary Table 1). All pregnant women tested for SARS-CoV-2 infection at any stage of gestation were eligible for inclusion in this multicenter study except those < 18 years of age as well as individuals declining to consent or not able to consent for themselves. Deidentified data were prospectively recorded by each center using the REDCap (Research Electronic Data Capture) electronic data capture tool^,. At inclusion (i.e. at the time of SARS-CoV-2 screening), the following data were recorded: socio-demographic characteristics, obstetrical history and information on SARS-CoV-2 exposure. Pregnancies were monitored as clinically indicated according to local protocols. After inclusion, the following data were collected: results of maternal testing (SARS-CoV-2 and/or other infectious pathogens), COVID-19 history, maternal, pregnancy and neonatal outcomes. Data were analyzed using Stata 14 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP). SARS-CoV-2, severe acute respiratory syndrome coronavirus 2WG, weeks ‘gestation.