BACKGROUND AND PURPOSE:

• This preprint (medRxiv, 2021), describes the incidence, characteristics and outcomes of hospitalized pregnant women with symptomatic and asymptomatic SARS-CoV-2 in the UK

METHODS:

• National, prospective cohort study
• Data source
  • UK Obstetric Surveillance System (UKOSS)
  • Started in 2005 to collect national population-based information about specific severe pregnancy complications
  • System already in place prior to COVID-19 pandemic
• Setting
  • All 194 hospitals in the UK with a consultant-led maternity unit
• Participants
  • All hospitalized pregnant women with confirmed SARS-CoV-2 (March 1, 2020 through August 31, 2021)
• Statistical analysis
  • Historical comparison cohort of 139 uninfected women used to ensure asymptotic patients with SARS-CoV-2 infection were not inadvertently included in the control group | Historic controls derived from a previous study of seasonal influenza in pregnancy

RESULTS:

• 1148 hospitalized patients with confirmed SARS-CoV-2 infection
  • Symptomatic: 63%
• Estimated incidence of hospitalizations (based on latest national maternity data)
  • Symptomatic: 2.0 per 1000 maternities (95% CI, 1.9 to 2.2)
  • Asymptomatic: 1.2 per 1000 maternities (95% CI, 1.1 to 1.4)
• Compared to uninfected pregnant women, women hospitalized with symptomatic SARS-CoV-2 were more likely
  • To be overweight or obese
    • Overweight: Adjusted OR 1.86 (95% CI, 1.39 to 2.48)
    • Obese: aOR 2.07 (95% CI, 1.53 to 2.29)
  • To be of Black, Asian or other minority ethnic group
    • Black: aOR 6.24 (95% CI, 3.93 to 9.90)
    • Asian: aOR 4.36 (95% CI, 3.19 to 5.95)
    • Other ethnic minority: aOR 12.95 (95% CI, 4.93 to 34.01)
  • To have a relevant medical comorbidity
    • aOR 1.83 (95% CI, 1.32 to 2.54)
• 63 women (5%) of hospitalized women with SARS-CoV-2 required critical care
  • Comprised 9% of women who were symptomatic
  • Of those, 4 (<1%) required ECMO
  • 56 women (92%) discharged home in good condition
  • 5 maternal deaths (8%) were recorded 
• Maternal mortality rate for hospitalized women: 2.2 per 100,000 maternities (95% CI, 0.9-4.3)
• Cesarean births and neonatal unit admission were increased in SARS-CoV-2 positive women, regardless of symptom status
  • Cesarean
    • Symptomatic: aOR 2.60 (95% CI, 1.97 to 3.42)
    • Asymptomatic: aOR 2.02 (95% CI, 1.52 to 2.70)
  • NICU admissions
    • Symptomatic: aOR 3.08 (95% CI, 1.99 to 4.77)
    • Asymptomatic: aOR 1.84 (95%, 1.12 to 3.03)
• Iatrogenic preterm births were more common in women with symptomatic SARS-CoV-2
  • aOR 11.43 (95% CI, 5.07 to 25.75)
• Risks of stillbirth or neonatal death were not significantly increased, regardless of symptom status (small ‘n’)

CONCLUSION:

• Hospitalized women with symptomatic COVID were associated with the following
  • Overweight or obese
  • Black, Asian, or other ethnic minority descent
  • Other comorbidities
• Women with symptomatic COVID were more likely to experience cesarean or iatrogenic preterm birth
• Most women with SARS-CoV-2 infection do not experience severe complications
• The authors conclude that for hospitalized women who are positive for SARS-CoV-2

Outcomes in this group are predominantly good, but women should be treated with medications known to be effective, to ensure their outcomes improve in line with the general population

The proportion of cesarean births and iatrogenic preterm birth is high which provides clear evidence of the indirect impact of SARS-CoV-2 on maternity care in 446 a high-income setting

Learn More – Primary Sources:

The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

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