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Grand Rounds

Pregnant Women with COVID-19 in France: Clinical Outcomes and Risk Factors for Severe Disease

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BACKGROUND AND PURPOSE:

  • Kayem et al. (Journal of Gynecology Obstetrics and Human Reproduction, 2020) describe the course of COVID-19 in French pregnant women

METHODS:

  • Case series (between March 1 and April 14, 2020)
  • Setting
    • 33 French maternity units
  • Participants
    • Pregnant women with confirmed COVID-19 (RT-PCR nasal sample or chest CT)
  • Data collection
    • Patient demographic data, baseline comorbidities, and pregnancy outcomes
  • Primary outcome
    • COVID-19: Requiring oxygen
    • Critical COVID-19: Invasive mechanical ventilation or ECMO

RESULTS:

  • Temporal trends
    • Active cases increased exponentially in March
    • Lockdown began March 17
    • April 1-14: Number of cases fell
    • On April 14th, there were 617 pregnant women with COVID-19
  • COVID-19 clinical outcomes (April 14)
    • Required oxygen therapy: 15.1% of cases (95% CI, 12.3 to 18.1; 93 patients)
    • Critical COVID-19: 5.7% of total cases (95% CI, 4.0 to 7.8; 35 cases)
    • Mortality: 0.2% of cases (95% CI, 0 to 0.9; 1 patient with critical disease)
  • Risk factors for serious disease
    • Age >35 years
    • Obesity
    • Preexisting diabetes
    • Previous preeclampsia
    • Gestational hypertension
    • Preeclampsia
  • 181 Women Delivered | Cesarean 48.1% | Cesarean for COVID-19 24.9%
    • Fetal loss (14 to 21 weeks): 2.8% (5/181 deliveries)
    • Intrauterine intrapartum fetal death: 1.3% (7/181)
  • Rates of preterm birth
    • <37 weeks
      • Non-severe cases: 10.6% (13 of 123 patients)
      • Oxygen-requiring cases: 48.3% (14 of 29 patients)
      • Critical cases: 79.3% (23 of 29 patients)
    • Before 32 weeks’
      • Non-severe cases: 2.4% (3 of 123 patients)
      • Oxygen-requiring cases: 13.8% (4 of 29 patients)
      • Critical cases: 48.3% (14 of 29 patients)
    • One neonate in the critical group died from prematurity
      • 0.5% (95% CI, 0.01 to 2.9)
  • Neonatal infection
    • 2 neonates (1.1%) were positive for SARS-CoV-2

CONCLUSIONS:

  • Risk factors for serious COVID-19 while pregnant are similar to risk factors for severe disease within the general population
    • Advanced age
    • Obesity
    • Hypertension and preeclampsia
    • Diabetes
  • Rates of preterm birth increased with worsening disease severity

Learn More – Primary Sources:

A snapshot of the Covid-19 pandemic among pregnant women in France

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Related ObG Topics:

118 Pregnant Women with COVID-19: Treatments and Outcomes
COVID-19 Case Series: Pregnancy and Infant Outcomes
CDC Reports on Pregnancy and COVID-19 Outcomes
The UKOSS COVID-19 Pregnancy Registry: Update on 427 Patients Admitted to Hospital

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