BACKGROUND AND PURPOSE:

• Villar et al. (JAMA Pediatr, 2021) evaluated the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected pregnant individuals

METHODS:

• Cohort study
• Participants
  • Pregnant women and their neonates
• Exposures
  • COVID-19 diagnosis in pregnancy
  • Between March and October 2020
• Study design
  •  COVID-19 diagnosis: One of the following
    • Laboratory confirmation
    • Radiological pulmonary findings
    • ≥2 predefined COVID-19 symptoms
  • Women and neonates were followed up until hospital discharge
  • Models for outcomes were adjusted for country, month entering study, maternal age, and history of morbidity
• Matching strategy: 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after identification of a COVID-19 positive pregnancy 
  •  2 women without COVID-19 diagnosis of similar gestational age (±2 weeks) receiving standard antenatal care were enrolled same day
  • If not possible or not-COVID-19 participants were lost to follow-up: 2 women without COVID-19 diagnosis who delivered immediately after the woman with COVID-19 diagnosis
• Primary outcome
  • Indices of (maternal and severe neonatal/perinatal) morbidity and mortality
• Secondary outcome
  • The individual components of the primary outcome indices

RESULTS:

• 706 pregnant women with COVID-19 | 1424 not-infected pregnant women
  • Mean age 30.2 years
  • There were more women with overweight early in pregnancy in those that were diagnosed with COVID-19 (48.6% vs 40.2%)
• Women with COVID-19 diagnosis were at higher risk for
  • Preeclampsia/eclampsia: RR 1.76 (95% CI, 1.27 to 2.43)
  • Severe infections: RR 3.38 (95% CI, 1.63 to 7.01)
  • Intensive care unit admission: RR 5.04 (95% CI, 3.13 to 8.10)
  • Maternal mortality: RR 22.3 (95% CI, 2.88 to 172)
  • Preterm birth: RR 1.59 (95% CI, 1.30 to 1.94)
  • Medically indicated preterm birth: RR 1.97 (95% CI, 1.56 to 2.51)
  • Severe neonatal morbidity index: RR 2.66 (95% CI, 1.69 to 4.18)
  • Severe perinatal morbidity and mortality index: RR 2.14 (95% CI, 1.66 to 2.75)
• Fever and shortness of breath for any duration was associated with increased risk of
  • Severe maternal complications: RR 2.56 (95% CI, 1.92 to 3.40)
  • Neonatal complications: RR 4.97 (95% CI, 2.11 to 11.69)
• Asymptomatic women with COVID-19 diagnosis were at higher risk for only a few complications
  • Maternal morbidity: RR 1.24 (95% CI, 1.00 to 1.54)
  • Preeclampsia: RR 1.63 (95% CI, 1.01 to 2.63)
• Among women who tested positive by PCR testing
  • 13% of their neonates tested positive
• There was an increased risk of neonatal test positivity with cesarean delivery, but not with breastfeeding
  • Cesarean delivery: RR 2.15 (95% CI, 1.18 to 3.91)
  • Breastfeeding: RR 1.10 (95% CI, 0.66 to 1.85)

CONCLUSION:

• In a large-scale, prospective, matched, multinational study that included pregnant women from 18 countries, SARS-CoV-2 infection was associated with an increased risk of complications, including preeclampsia, mortality, preterm birth
• Asymptomatic women were generally at similar risk levels to not-COVID-19 women except for preeclampsia
• The authors state specifically regarding preeclampsia

…women with COVID-19 diagnosis, already at high risk of preeclampsia and COVID-19 because of preexisting overweight, diabetes, hypertension, and cardiac and chronic respiratory diseases,28 had almost 4 times greater risk of developing preeclampsia/eclampsia, which could reflect the known association with these comorbidities and/or the acute kidney damage that can occur in patients with COVID-19

Our data support reports of an association between COVID-19 and higher rates of preeclampsia/eclampsia/HELLP syndrome, but it is still uncertain whether COVID-19 manifests in pregnancy with a preeclampsialike syndrome or infection with SARS-CoV-2 results in an increased risk for preeclampsia

Learn More – Primary Sources:

Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study

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