BACKGROUND AND PURPOSE:

• Jering et al. (JAMA Internal Medicine, 2021) compared the clinical characteristics and outcomes of hospitalized women who gave birth with and without COVID-19

METHODS:

• Cohort study
• Data source
  • Premier Healthcare Database | Includes ~20% of all US hospitalizations
• Participants
  • Women giving birth who were discharged between April 1 and November 23, 2020
• Study design
  • Characteristics included: Race/ethnicity (self-reported) | COVID-19 status | Comorbidities | In-hospital outcomes 
  • Associations between COVID-19 and in-hospital outcomes were examined using propensity score-adjusted regression
  • Logistic regression analysis used to determine risk factors for in-hospital death or mechanical ventilation

RESULTS:

• 406,446 women admitted for delivery
  • Incidence of COVID-19: 1.6% (6380 women)
• Compared to pregnant women without COVID-19, women with COVID-19 were more likely to be
  • Black and/or Hispanic
  • Diabetic
  • Obese
• Maternal outcomes
  • Discharged home: 98.9%
  • Intensive care: 3.3%
  • Mechanical ventilation: 1.3%
  • Died in the hospital: 0.1%
• In-hospital mortality was overall low but still significantly higher in pregnant women with COVID-19
  • With COVID-19: 141 deaths/100,000 women (95% CI, 65 to 268)
  • Without: 5.0 deaths/100,000 women (95% CI, 3.1 to 7.7)
• Rates of myocardial infarction and venous thromboembolism (VTE) were higher in the women with COVID-19 (P < 0.001)
  • Myocardial infarction
    • With COVID-19: 0.1%
    • Without: 0.004%
  • VTE
    • With COVID-19: 0.2%
    • Without: 0.1%
• COVID-19 was associated with higher odds of
  • Preeclampsia
    • Adjusted odds ratio (aOR) 1.21 (95% CI, 1.11 to 1.33)
  • Preterm birth
    • aOR 1.17 (95% CI, 1.06 to 1.29)
• COVID-19 was not associated with higher odds of stillbirth
  • aOR 1.23 (95% CI, 0.87 to 1.75)
• Use of the following was higher in women who gave birth with COVID-19
  • Chest imaging
  • Intensive care treatment
  • Mechanical ventilation
• The following were associated with higher odds of mechanical ventilation or in-hospital death among women with COVID-19
  • Age: OR 1.91 (95% CI, 1.31 to 2.77) per 10 years
  • Morbid obesity: OR 3.85 (95% CI, 2.05 to 7.21)
  • Diabetes: OR 4.51 (95% CI, 2.10 to 9.70)
  • Kidney disease: OR 21.57 (95% CI, 7.73 to 60.10)
  • Eclampsia: OR 116.1 (95% CI, 22.91 to 588.50)
  • Thrombotic events: OR 45.10 (95% CI, 17.13 to 118.8)
  • Stillbirth: OR 7.88 (95% CI, 2.39 to 25.98)

CONCLUSION:

• In this large population of US women giving birth, mortality and adverse events were rare, even with COVID-19
• However, the risk of in-hospital death, VTE and preeclampsia was significantly higher in women with COVID-19
• The authors conclude

As studies investigating therapies for COVID-19 have largely excluded pregnant women, the data also underscore the importance of including this population in clinical trials of treatments and vaccines

Learn More – Primary Sources:

Clinical Characteristics and Outcomes of Hospitalized Women Giving Birth With and Without COVID-19

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