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Observational Study
. 2023 Jan 1;141(1):109-118.
doi: 10.1097/AOG.0000000000004982. Epub 2022 Oct 27.

Association Between Giving Birth During the Early Coronavirus Disease 2019 (COVID-19) Pandemic and Serious Maternal Morbidity

Torri D Metz  1 , Rebecca G Clifton, Brenna L Hughes, Grecio J Sandoval, William A Grobman, George R Saade, Tracy A Manuck, Monica Longo, Amber Sowles, Kelly Clark, Hyagriv N Simhan, Dwight J Rouse, Hector Mendez-Figueroa, Cynthia Gyamfi-Bannerman, Jennifer L Bailit, Maged M Costantine, Harish M Sehdev, Alan T N Tita, George A Macones; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Affiliations
Observational Study

Association Between Giving Birth During the Early Coronavirus Disease 2019 (COVID-19) Pandemic and Serious Maternal Morbidity

Torri D Metz et al. Obstet Gynecol. .

Abstract

Objective: To evaluate whether delivering during the early the coronavirus disease 2019 (COVID-19) pandemic was associated with increased risk of maternal death or serious morbidity from common obstetric complications compared with a historical control period.

Methods: This was a multicenter retrospective cohort study with manual medical-record abstraction performed by centrally trained and certified research personnel at 17 U.S. hospitals. Individuals who gave birth on randomly selected dates in 2019 (before the pandemic) and 2020 (during the pandemic) were compared. Hospital, health care system, and community risk-mitigation strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in response to the early COVID-19 pandemic are described. The primary outcome was a composite of maternal death or serious morbidity from common obstetric complications, including hypertensive disorders of pregnancy (eclampsia, end organ dysfunction, or need for acute antihypertensive therapy), postpartum hemorrhage (operative intervention or receipt of 4 or more units blood products), and infections other than SARS-CoV-2 (sepsis, pelvic abscess, prolonged intravenous antibiotics, bacteremia, deep surgical site infection). The major secondary outcome was cesarean birth.

Results: Overall, 12,133 patients giving birth during and 9,709 before the pandemic were included. Hospital, health care system, and community SARS-CoV-2 mitigation strategies were employed at all sites for a portion of 2020, with a peak in modifications from March to June 2020. Of patients delivering during the pandemic, 3% had a positive SARS-CoV-2 test result during pregnancy through 42 days postpartum. Giving birth during the pandemic was not associated with a change in the frequency of the primary composite outcome (9.3% vs 8.9%, adjusted relative risk [aRR] 1.02, 95% CI 0.93-1.11) or cesarean birth (32.4% vs 31.3%, aRR 1.02, 95% CI 0.97-1.07). No maternal deaths were observed.

Conclusion: Despite substantial hospital, health care, and community modifications, giving birth during the early COVID-19 pandemic was not associated with higher rates of serious maternal morbidity from common obstetric complications.

Clinical trial registration: ClinicalTrials.gov, NCT04519502.

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Conflict of interest statement

Financial Disclosure Torri D. Metz reports personal fees from Pfizer for her role as a medical consultant for a SARS-CoV-2 vaccination in pregnancy study, grants from Pfizer for role as a site PI for SARS-CoV-2 vaccination in pregnancy study, grants from Pfizer for role as a site PI for RSV vaccination in pregnancy study, and grants from Gestvision for role as a site PI for a preeclampsia study outside the submitted work. Brenna L. Hughes reports personal fees from Merck for her role on a Medical Advisory Board outside of the submitted work. Tracy A. Manuck reports money was paid to her institution from the NIH (NICHD and NIEHS) and the State of North Carolina (PFAST Network Grant). She also received Cefalo Bowes grant funding (local UNC obgyn grant funding) where she was a mentor to fellow physicians. Hyagriv N. Simhan reports that he is an LLC Co-founder of Naima Health and personal fees from UpToDate outside of the submitted work. Cynthia Gyamfi-Bannerman reports receiving payment from Medela and Hologic. Alan T.N. Tita reports grants from CDC and from Pfizer for a COVID-19 in pregnancy trial outside of the submitted work. The other authors did not report any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Study population. MFMU, Maternal-Fetal Medicine Units Network; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2.
Figure 2.
Graphical depiction of the proportion of patients positive for severe acute respiratory syndrome coronavirus 2, across the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network over the study period on a monthly basis. Squares indicates percent, bars indicate 95% CI.
Figure 3.
Figure 3.
Descriptive data for modifications to hospital, health care system, and community-level mitigation strategies for severe acute respiratory syndrome coronavirus 2 during the pandemic in 2020. A. Hospital-level modifications including changes to the compliment of trainees on the obstetric service (medical students, residents, or fellows), changes in staffing on Labor and Delivery, changes in faculty members on Labor and Delivery (eg, coverage by individuals who do not normally do obstetrics as part of their practices). B. Health care systems modifications including changes in frequency of in-person visits or use of telehealth, changes in frequency of ultrasonograms or antenatal surveillance, implementation of a policy to conserve blood products, and implementation of a policy to limit the number of visitors on Labor and Delivery. C. Community-level modifications including school, restaurant, or business closures, and shelter-in-place orders.
Figure 4.
Figure 4.
Prevalence of primary composite outcome of maternal death or serious morbidity from common obstetric complications with 95% CIs by month. Before pandemic is represented in light grey and during pandemic is represented in dark grey. Dashed lines denote the overall prevalence of the primary outcome for March through December of each calendar year.
See this image and copyright information in PMC

References

    1. Woolf SH, Chapman DA, Sabo RT, Zimmerman EB. Excess deaths from COVID-19 and other causes in the US, March 1, 2020 to January 2, 2021. JAMA 2021; 325(17): 1786–9. doi: 10.1001/jama.2021.5199 - DOI - PMC - PubMed
    1. Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022. DOI: 10.15620/cdc:113967. - DOI
    1. Metz TD, Collier C, Hollier LM. Maternal mortality from coronavirus disease 2019 (COVID-19) in the United States. Obstet Gynecol 2020; 136(2):313–6. doi: 10.1097/AOG.0000000000004024 - DOI - PubMed
    1. Metz TD, Clifton RC, Hughes BL, et al. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID-19). Obstet Gynecol 2021; 137(4):571–80. doi: 10.1097/AOG.0000000000004339 - DOI - PMC - PubMed
    1. Metz TD, Clifton RG, Hughes BL, et al. Association of SARS-CoV-2 Infection with Serious Maternal Morbidity and Mortality from Obstetric Complications. JAMA 2022; 327(8):748–59. doi: 10.1001/jama.2022.1190. - DOI - PMC - PubMed

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