Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State

Abstract

Background: The impact of coronavirus disease 2019 on pregnant women is incompletely understood, but early data from case series suggest a variable course of illness from asymptomatic or mild disease to maternal death. It is unclear whether pregnant women manifest enhanced disease similar to influenza viral infection or whether specific risk factors might predispose to severe disease.

Objective: To describe maternal disease and obstetrical outcomes associated with coronavirus disease 2019 in pregnancy to rapidly inform clinical care.

Study design: This is a retrospective study of pregnant patients with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 6 hospital systems in Washington State between Jan. 21, 2020, and April 17, 2020. Demographics, medical and obstetrical history, and coronavirus disease 2019 encounter data were abstracted from medical records.

Results: A total of 46 pregnant patients with a severe acute respiratory syndrome coronavirus 2 infection were identified from hospital systems capturing 40% of births in Washington State. Nearly all pregnant individuals with a severe acute respiratory syndrome coronavirus 2 infection were symptomatic (93.5%, n=43) and the majority were in their second or third trimester (43.5% [n=20] and 50.0% [n=23], respectively). Symptoms resolved in a median of 24 days (interquartile range, 13-37). Notably, 7 women were hospitalized (16%) including 1 admitted to the intensive care unit. A total of 6 cases (15%) were categorized as severe coronavirus disease 2019 with nearly all patients being either overweight or obese before pregnancy or with asthma or other comorbidities. Of the 8 deliveries that occurred during the study period, there was 1 preterm birth at 33 weeks' gestation to improve pulmonary status in a woman with class III obesity, and 1 stillbirth of unknown etiology.

Conclusion: Severe coronavirus disease 2019 developed in approximately 15% of pregnant patients and occurred primarily in overweight or obese women with underlying conditions. Obesity and coronavirus disease 2019 may synergistically increase risk for a medically indicated preterm birth to improve maternal pulmonary status in late pregnancy. These findings support categorizing pregnant patients as a higher-risk group, particularly those with chronic comorbidities.

Keywords: asthma; coronavirus disease 2019; fetal death; infection; maternal morbidity; obesity; overweight; pregnancy; preterm birth; respiratory insufficiency; severe acute respiratory syndrome coronavirus 2; stillbirth.

Figure

Timeline of symptom onset and resolution, laboratory testing, COVID-19 hospital admission, and delivery for 46 pregnant patients Time is indicated on the x-axis and is measured by gestational age in weeks. Each line of the y-axis reflects an individual patient. Gestational age of the first positive SARS-CoV-2 test (red star), length of symptoms (black lines), gestational age at symptom onset (black dot), gestational age or days postpartum at symptom resolution (black dot if resolved and a black arrow if ongoing at last encounter [censoring]), length of COVID-19 hospitalizations (gray bar), and gestational age at delivery (blue vertical line) are indicated for each patient, as applicable. Three patients were asymptomatic. Of the 7 patients hospitalized for COVID-19–associated respiratory concerns, 6 were severe (Table 3). COVID-19, coronavirus disease 2019; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Lokken et al. COVID-19 in pregnant women in Washington State. Am J Obstet Gynecol 2020.

Supplemental Figure

Days to symptom resolution This Kaplan–Meier curve depicts days to symptom resolution in 43 symptomatic pregnant patients with data on gestational age at symptom onset. Median time to symptom resolution was 24 days (IQR, 13–37). Symptoms were reported by patients at each clinical encounter (virtual, outpatient, admissions) for SARS-CoV-2 testing and follow-up. Patients with ongoing symptoms were censored at the last report of symptoms (no resolution data available). IQR, interquartile range; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Lokken et al. COVID-19 in pregnant women in Washington State. Am J Obstet Gynecol 2020.