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COVID-19 and Women’s Health

COVID-19 during Pregnancy: Outcomes Reported from Washington State

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BACKGROUND AND PURPOSE:

  • Lokken et al. (AJOG, 2021) provide data on disease severity and outcomes of SARS-CoV-2 infections in pregnancy across Washington State

METHODS:

  • Multi-center retrospective cohort study (between March 1 and June 30, 2020)
  • Setting
    • 35 sites in Washington State | 61% of annual state deliveries
  • Participants
    • Pregnant patients with SARS-CoV-2 infection (PCR confirmed)
  • Study design
    • Case fatality rates in in pregnancy were compared to COVID-19 fatality rates in similarly aged adults in Washington State using rate ratios and rate differences
    • Maternal and neonatal outcomes were compared by trimester of infection and disease severity at the time of delivery

RESULTS:

  • 240 pregnant patients
  • Overall outcomes
    • Developed severe or critical disease: 1 in 11 patients
    • Hospitalized for COVID-19: 1 in 10 patients
    • Deaths: 1 in 80 patients

Hospitalizations

  • The COVID-19-associated hospitalization rate was significantly increased in pregnant patients than in non-pregnant people of a similar age
    • Pregnant: 10.0% hospitalized
    • Non-pregnant: 2.8% hospitalized
    • Rate ratio (RR) 3.5 (95% CI, 2.3 to 5.3)
  • Pregnant patients hospitalized with respiratory compromise were more likely to have a comorbidity such as
    • Asthma
    • Hypertension
    • Type 2 diabetes
    • Autoimmune disease
    • Class II obesity

Maternal Mortality

  • COVID-19-related maternal deaths
    • Maternal mortality rate: 1,250 out of 100,000 pregnancies (95% CI, 257 to 3,653)
  • The COVID-19 case fatality in pregnancy was significantly increased (95% CI, 2.7 to 43.6) in pregnant patients than in similarly aged non-pregnant people
    • Absolute difference in mortality rate: 1.2% (95% CI, –0.3 to 2.6)

Preterm Birth

  • Preterm birth was significantly higher among women with severe or critical COVID-19 at delivery than for women who had recovered from COVID-19 (P<0.001)
    • Severe or critical: 45.4%
    • Recovered: 5.2%

CONCLUSION:

  • The COVID-19-associated hospitalization rate was 3.5-fold higher in pregnant vs non-pregnant people
  • The COVID-19 case fatality rate in pregnancy was 13.6-fold higher
  • Pregnant patients with COVID-19 had higher rates of hospitalization and case fatality than did similarly aged non-pregnant individuals
  • Risk of preterm birth was also higher among patients with severe COVID-19
  • The authors conclude

These data strongly support the need to offer vaccination to pregnant women at risk of acquiring SARS-CoV-2 infection and include pregnant people in clinical trials and other observational evaluations of vaccines and COVID-19 therapies

Learn More – Primary Sources:

Disease Severity, Pregnancy Outcomes and Maternal Deaths among Pregnant Patients with SARS-CoV-2 Infection in Washington State

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Related ObG Topics:

COVID-19 Infection Rates in Healthcare Personnel: Data from Washington State
Pregnant Women with COVID-19 at Time of Delivery: NYC Cohort Characteristics and Outcomes
The UKOSS COVID-19 Pregnancy Registry: Update on 427 Patients Admitted to Hospital

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