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. 2023 Nov;102(11):1521-1530.
doi: 10.1111/aogs.14643. Epub 2023 Aug 18.

Variations across Europe in hospitalization and management of pregnant women with SARS-CoV-2 during the initial phase of the pandemic: Multi-national population-based cohort study using the International Network of Obstetric Survey Systems (INOSS)

Odette de Bruin  1   2 , Hilde Engjom  3   4 , Nicola Vousden  5 , Rema Ramakrishnan  5 , Anna J M Aabakke  6   7 , Outi Äyräs  8 , Serena Donati  9 , Eva Jónasdóttir  10 , Marian Knight  5 , Evelien M Overtoom  1 , Michele A Salvatore  9 , Miriam C J M Sturkenboom  2 , Teresia Svanvik  11 , Reetta Varpula  8 , An Vercoutere  12 , Kitty W M Bloemenkamp  1 ; INOSS COVID-19 Working Group
Affiliations

Variations across Europe in hospitalization and management of pregnant women with SARS-CoV-2 during the initial phase of the pandemic: Multi-national population-based cohort study using the International Network of Obstetric Survey Systems (INOSS)

Odette de Bruin et al. Acta Obstet Gynecol Scand. 2023 Nov.

Abstract

Introduction: The majority of data on COVID-19 in pregnancy are not from sound population-based active surveillance systems.

Material and methods: We conducted a multi-national study of population-based national or regional prospective cohorts using standardized definitions within the International Network of Obstetric Survey systems (INOSS). From a source population of women giving birth between March 1 and August 31, 2020, we included pregnant women admitted to hospital with a positive SARS-CoV-2 PCR test ≤7 days prior to or during admission and up to 2 days after birth. The admissions were further categorized as COVID-19-related or non-COVID-19-related. The primary outcome of interest was incidence of COVID-19-related hospital admission. Secondary outcomes included severe maternal disease (ICU admission and mechanical ventilation) and COVID-19-directed medical treatment.

Results: In a source population of 816 628 maternities, a total of 2338 pregnant women were admitted with SARS-CoV-2; among them 940 (40%) were COVID-19-related admissions. The pooled incidence estimate for COVID-19-related admission was 0.59 (95% confidence interval 0.27-1.02) per 1000 maternities, with notable heterogeneity across countries (I2 = 97.3%, P = 0.00). In the COVID-19 admission group, between 8% and 17% of the women were admitted to intensive care, and 5%-13% needed mechanical ventilation. Thromboprophylaxis was the most frequent treatment given during COVID-19-related admission (range 14%-55%). Among 908 infants born to women in the COVID-19-related admission group, 5 (0.6%) stillbirths were reported.

Conclusions: During the initial months of the pandemic, we found substantial variations in incidence of COVID-19-related admissions in nine European countries. Few pregnant women received COVID-19-directed medical treatment. Several barriers to rapid surveillance were identified. Investment in robust surveillance should be prioritized to prepare for future pandemics.

Keywords: COVID-19; SARS-CoV-2; hospitalization; neonate; obstetric surveillance system; pregnancy.

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Conflict of interest statement

OB declares support from the European Medicines agency (EMA). HE declares grants from the Nordic Federation of Societies of Obstetrics and Gynecology (NFOG) and Norwegian Research Council (grant no 320181). AA declares a grant from the Region of Southern Denmark and Region Zealand's shared fund for joint health research projects. OA declares grants from the Finnish Medical Association and NFOG. MK declares grants from the National Institute for Health and Care Research, Medical Research Council, Healthcare Quality Improvement Partnership and Wellbeing of Women during the course of the study. MS leads a department that conducts studies on COVID‐19 vaccines for the European Medicines Agency, Pfizer, AstraZeneca and Janssen. All support was according to the ENCePP code of conduct. None of the other authors (NV, RR, SD, EJ, EO, MAS, TS, RV, AV, KB) has anything to disclose.

Figures

FIGURE 1
FIGURE 1
Overview of SARS‐CoV‐2 testing strategies in pregnancy in the seven European countries from March to August 2020. In Belgium there were no national testing strategies and testing strategies differed across hospitals and regions. Similarly, testing strategies differed across hospitals and regions in Sweden, with early implementation of universal testing in Stockholm.
FIGURE 2
FIGURE 2
Pooled risk of hospitalization per 1000 maternities by cause of admission.
FIGURE 3
FIGURE 3
Admission due to COVID‐19 per 1000 maternities per month of first positive PCR test, March to August 2020, by country.
See this image and copyright information in PMC

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