PURPOSE:

Breslin et al. (AJOG MFM, 2020) provide follow-up on 43 pregnant women with confirmed SARS-CoV-2 infection.

METHODS:

• Retrospective review (March 13 to March 27, 2020)
  • 2 Affiliated hospitals in New York City
• Participants
  • Pregnant women with confirmed SARS-C0V-2 infection (nasopharyngeal swab)
  • Diagnosed in triage or direct L&D admission
• Study design
  • Initially, pregnant women were screened if they were symptomatic
  • March 22, universal COVID-19 screening was initiated for women admitted to L&D unit
  • Medical records of mothers and newborns were reviewed
• Women were divided in to 2 cohorts for reporting outcomes
  • Symptomatic presentation
  • Asymptomatic | Identified via viral screening

RESULTS:

Maternal Results

• 43 pregnant patients
  • Obesity: 60.5% | 2 women had BMI >40
  • Most common comorbidity: Asthma: 18.6% (n=8)
  • Additional comorbidities: Type 2 diabetes | Chronic hypertension
  • Severity: Mild disease (nonpneumonia and mild pneumonia): 86% | Severe disease: 9.3% | Critical: 4.7%

Symptomatic: 67.4% (n=29)

• Mild disease: 90% (n=26)
  • Outpatient management at time of publication: 22 patients
  • Admitted for Ob management: 4 patients (term labor, preterm labor, IOL, term PROM)
• Severe disease leading to antenatal admission: 10.3% (n=3)
  • 1 patient treated with hydroxychloroquine | 1 patient treated with IV hydration | 1 patient treated with ceftriaxone and azithromycin (suspected bacterial pneumonia)
• Postpartum admission 6 days post successful IOL with severe disease: 3% (n=1)
  • Severe disease treated with hydroxychloroquine

Asymptomatic: 32.6% (n=14)

• COVID-19 symptom development: 71.4% (n=10)
• 2 of the 10 patients who became symptomatic required ICU admission: 1 patient discharged, and 1 patient was an inpatient at time of publication

Neonatal Results

• 18 infants
  • All had normal Apgars
  • None were positive for SARS-CoV-2 infection
  • None were positive for IgG or IgM
  • All discharged home at time of publication
• NICU admission
  • Prematurity (34w6d) | Multicystic dysplastic kidney (term) | Respiratory distress/sepsis
• “Healthy newborns either roomed in with their mothers in isolettes whenever possible or were cared for in an isolated nursery for babies of COVID-positive mothers throughout their stay”
  • Breastfeeding encouraged with maternal masking and hand hygiene

CONCLUSION:

• Significant percentage of women were asymptomatic on presentation to triage and L&D, supporting the use of universal testing prior to L&D admission
• Pattern of disease severity matches previous reports in nonpregnant individuals
  • Large series from China in JAMA (see ‘Learn More – Primary Sources’ below): Mild: 81% | Severe: 14% | Critical: 5%
• Authors recommend COVID-19 infection should be included in the differential when previous asymptomatic patients develop postoperative infections
• In reference to the use of hydroxychloroquine and other medications, the authors state

Despite these women having similar objective findings, they received different treatments after consultation with the infectious disease specialists, likely due to nuances in their clinical characteristics and evolving recommendations

Learn More – Primary Sources:

COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals

Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China (JAMA, 2020)

Related ObG Topics:

ACOG COVID-19 FAQs for Obstetrical Care

U.S. COVID-19 PRIORITY Pregnancy Registry Now Open

COVID-19 and Pregnancy: Literature Review and Comparisons to SARS and MERS

Clinical Characteristics of Pregnant Women with COVID-19 Pneumonia