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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