COVID-19 in pregnancy was associated with maternal morbidity and preterm birth

Am J Obstet Gynecol. 2020 Jun 15;S0002-9378(20)30639-6. doi: 10.1016/j.ajog.2020.06.022. Online ahead of print.

Abstract

Background: Despite the mainly reassuring outcomes for pregnant women with COVID-19 infection reported by previous case series with small sample sizes, some recent reports of severe maternal morbidity requiring intubation and of maternal deaths show the need for additional data about the impact of COVID-19 on pregnancy outcomes. This study aimed to report the maternal characteristics and clinical outcomes of pregnant women with COVID-19 disease.

Study design: This retrospective single-center study includes all consecutive pregnant women with confirmed (laboratory-confirmed) or suspected (according to version 7.0 of the Chinese management guideline) COVID-19 infection, regardless of gestational age at diagnosis, admitted to the Strasbourg University Hospital (France) from March 1 to April 3, 2020. Maternal characteristics, laboratory and imaging findings, and maternal and neonatal outcomes were extracted from medical records.

Results: The study includes 54 pregnant women with confirmed (n=38) and suspected (n=16) COVID-19 infection. Of these, 32 had an ongoing pregnancy, one a miscarriage, and 21 live births: 12 vaginal and 9 cesarean deliveries. Among the women who gave birth, preterm deliveries were medically indicated for their COVID-19-related condition for 23.8% (5/21): 14.3% (3/21) before 32 weeks' gestation and 9.5% (2/21) before 28 weeks. Oxygen support was required for 24.1% (13/54), including high flow oxygen (n=2), noninvasive (n=1) and invasive (n=3) mechanical ventilation, and extracorporeal membrane oxygenation (n=1). Of these, three, aged 35 years or older with positive COVID-19 RT-PCR, had respiratory failure requiring indicated delivery before 29 weeks' gestation. All three women were overweight or obese, and two had an additional comorbidity.

Conclusion: COVID-19 in pregnancy was associated with maternal morbidity and preterm birth. Its association with other well-known risk factors for severe maternal morbidity in noninfected pregnant women, including maternal age above 35 years, overweight, and obesity, suggests further studies are required to determine whether these risk factors are also associated with poorer maternal outcome in these women.

Keywords: COVID-19 infection or pneumonia; extracorporeal membrane oxygenation; intubation; maternal and neonatal outcomes; maternal morbidity; pregnancy; preterm birth; respiratory failure.