Coronavirus Disease 2019 (COVID-19) pregnancy outcomes in a racially and ethnically diverse population

Am J Obstet Gynecol MFM. 2020 Oct 7;100246. doi: 10.1016/j.ajogmf.2020.100246. Online ahead of print.

Abstract

Background: Older age and medical comorbidities are identified risk factors for developing severe COVID-19. However, there are limited data on risk stratification, clinical and laboratory course, and optimal management of COVID-19 in pregnancy.

Objective: Our study aims to describe the clinical course of COVID-19, effect of comorbidities on disease severity, laboratory trends, and pregnancy outcomes of symptomatic and asymptomatic SARS-CoV-2 positive pregnant women.

Study design: This is a case series of pregnant and postpartum women who tested positive for SARS-CoV-2 between 3/1/2020 and 5/11/2020 within 3 hospitals of the Yale-New Haven Health delivery network. Charts were reviewed for basic sociodemographic and pre-pregnancy characteristics, COVID-19 course, laboratory values, and pregnancy outcomes.

Results: Out of 1,567 tested pregnant and postpartum women between 3/1/2020 and 5/11/2020, 9% (n=141) had a positive SARS-CoV-2 result. Hispanic women were overrepresented in the SARS-CoV-2 positive group (n=61; 43.8%). Additionally, Hispanic ethnicity was associated with higher rate of moderate and severe disease compared to non-Hispanic (18% (11/61) vs 3.8% (3/78), respectively, OR 5.5 95% CI 1.46-20.7, p=0.01). Forty-four women (31.2%) were asymptomatic, 37 (26.2%) of whom were diagnosed on universal screening upon admission for delivery. Fifty-nine percent (n=83) were diagnosed antepartum, 36% (n=51) upon presentation for childbirth and 5% (n=7) postpartum. Severe disease was diagnosed in 6 cases (4.3%) and there was one maternal death. Obese women were more likely to develop moderate and severe disease than non-obese women (16.4% (9/55) vs 3.8% (3/79), OR 4.96, 95%CI 1.28-19.25, p=0.02). Hypertensive disorders of pregnancy were diagnosed in 22.3% (17/77) of women who delivered after 20 weeks. Higher levels of C-reactive protein during antepartum COVID-19-related admission were more common in women with worse clinical course; this association, however, did not reach statistical significance.

Conclusion: COVID-19 in pregnancy may result in severe disease and death. Hispanic women were more likely to test positive for SARS-CoV-2 than other ethnic groups. Obesity and Hispanic ethnicity represent risk factors for moderate and severe disease.

Keywords: COVID-19; Hispanic ethnicity; SARS-CoV-2; coronavirus; pregnancy.