Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;101(4):461-470.
doi: 10.1111/aogs.14329. Epub 2022 Feb 25.

Management and implications of severe COVID-19 in pregnancy in the UK: data from the UK Obstetric Surveillance System national cohort

Nicola Vousden  1 , Rema Ramakrishnan  1 , Kathryn Bunch  1 , Edward Morris  2 , Nigel Simpson  3 , Christopher Gale  4 , Pat O'Brien  2   5 , Maria Quigley  1 , Peter Brocklehurst  6 , Jennifer J Kurinczuk  1 , Marian Knight  1
Affiliations

Management and implications of severe COVID-19 in pregnancy in the UK: data from the UK Obstetric Surveillance System national cohort

Nicola Vousden et al. Acta Obstet Gynecol Scand. 2022 Apr.

Abstract

Introduction: There is a lack of population level data on risk factors and impact of severe COVID-19 in pregnancy. The aims of this study were to determine the characteristics, and maternal and perinatal outcomes associated with severe COVID-19 in pregnancy compared with those with mild and moderate COVID-19 and to explore the impact of timing of birth.

Material and methods: This was a secondary analysis of a national, prospective cohort study. All pregnant women admitted to hospital in the UK with symptomatic SARS-CoV-2 from March 1, 2020 to October 31, 2021 were included. The severity of maternal infection (need for high flow or invasive ventilation, intensive care admission or died), pregnancy and perinatal outcomes, and the impact of timing of birth were analyzed using multivariable logistic regression.

Results: Of 4436 pregnant women, 13.9% (n = 616) had severe infection. Women with severe infection were more likely to be aged ≥30 years (adjusted odds ratio [aOR] aged 30-39 1.48, 95% confidence interval [CI] 1.20-1.83), be overweight or obese (aOR 1.73, 95% CI 1.34-2.25 and aOR 2.52 95% CI 1.97-3.23, respectively), be of mixed ethnicity (aOR 1.93, 95% CI 1.17-3.21) or have gestational diabetes (aOR 1.43, 95% CI 1.09-1.87) compared with those with mild or moderate infection. Women with severe infection were more likely to have a pre-labor cesarean birth (aOR 8.84, 95% CI 6.61-11.83), a very or extreme preterm birth (28-31+ weeks' gestation, aOR 18.97, 95% CI 7.78-14.85; <28 weeks' gestation, aOR 12.35, 95% CI 6.34-24.05) and their babies were more likely to be stillborn (aOR 2.51, 95% CI 1.35-4.66) or admitted to a neonatal unit (aOR 11.61, 95% CI 9.28-14.52). Of 112 women with severe infection who were discharged and gave birth at a later admission, the majority gave birth ≥36 weeks (85.7%), noting that three women in this group (2.7%) had a stillbirth.

Conclusions: Severe COVID-19 in pregnancy increases the risk of adverse outcomes. Information to promote uptake of vaccination should specifically target those at greatest risk of severe outcomes. Decisions about timing of birth should be informed by multidisciplinary team discussion; however, our data suggest that women with severe infection who do not require early delivery have mostly good outcomes but that those with severe infection at term may warrant rapid delivery.

Keywords: COVID-19; adverse maternal and perinatal outcome; population cohort; pregnancy.

PubMed Disclaimer

Conflict of interest statement

MK, MQ, PB, PO’B, JJK received grants from the NIHR in relation to the submitted work. EM is a Trustee of the Royal College of Obstetricians and Gynaecologists, British Menopause Society and Newly Chair of the Board of Trustees Group B Strep Support. CG was financially supported by the Medical Research Council through a Clinician Scientist Fellowship. PB was past chair of the MRC/NIHR Methodology Research Program panel with previous grant funding from MRC, NIHR and Welcome trust and provides consultancy services for personal fees to AG Biotest. KB, NV and NS have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Predictive margins of time from diagnosis to birth and severity of infection across all gestational ages
See this image and copyright information in PMC

Comment in

  • Moving on to older years.
    Geirsson RT. Geirsson RT. Acta Obstet Gynecol Scand. 2022 Apr;101(4):386-387. doi: 10.1111/aogs.14349. Acta Obstet Gynecol Scand. 2022. PMID: 35352821 Free PMC article. No abstract available.

References

    1. Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta‐analysis. BMJ. 2020;370:m3320. - PMC - PubMed
    1. Metz TD, Clifton RG, Hughes BL, et al. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID‐19). Obstet Gynecol. 2021;137:571‐580. - PMC - PubMed
    1. Lokken EM, Huebner EM, Taylor GG, et al. Disease severity, pregnancy outcomes, and maternal deaths among pregnant patients with severe acute respiratory syndrome coronavirus 2 infection in Washington State. Am J Obstet Gynecol. 2021;225:77.e1‐77.e14. - PMC - PubMed
    1. Vousden N, Bunch K, Morris E, et al. The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS‐CoV‐2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS). PLoS One. 2021;16:e0251123. - PMC - PubMed
    1. Badr DA, Picone O, Bevilacqua E, et al. Severe acute respiratory syndrome coronavirus 2 and pregnancy outcomes according to gestational age at time of infection. Emerg Infect Dis. 2021;27:2535‐2543. - PMC - PubMed