BACKGROUND AND PURPOSE:

• The Delta variant of SARS-CoV-2 (B.1.617.2) has become predominant in the US, starting in June/July of 2021
• Adhikari et al. (AJOG, 2021) report illness severity trends among obstetric patients with COVID-19 on a background of Delta variant predominance

METHODS:

• Prospective cohort study
  • Diagnosis between May 2020 and September 2021
• Participants
  • Pregnant patients
  • PCR-confirmed SARS-CoV-2 infection
• Study design
  • Universal Obstetric SARS-COV-2 screening upon hospital admission
  • Severe/critical illness definition: Requiring supplemental oxygen | High-flow nasal cannula | ICU admission | Mechanical ventilation
  • Management of illness
    • Mild to moderate illness: Symptom treatment and isolation precautions with virtual or in-person follow-up
    • Severe or critical illness: Administration of dexamethasone or other therapies according to NIH guidelines
  • Local SARS-CoV-2 Delta variant sequencing was performed and tracked weekly
• Primary outcome
  • The association between severe or critical illness and week of diagnosis

RESULTS:

• 1515 pregnant patients received COVID-19 diagnosis
  • Severe/critical illness: 5.4%
  • Requiring mechanical ventilation: 0.7%
  • Maternal deaths with surviving neonate: 0.1%
  • Fetal/neonatal deaths with maternal critical illness: 0.1%
• As the Delta variant predominated locally
  • Case volume and proportion of severe/critical illness increased significantly (P=0.001 for trend)
• 665 patients still pregnant or immediately postpartum when vaccines became available
  • Received at least one dose of an available vaccine: 21.4%

CONCLUSION:

• There was an increased COVID-19 case volume and severity in pregnant patients as the Delta variant predominated in the local region
• The authors conclude

Potential pathophysiologic mechanisms for increased severity of illness with B.1.617.2 in pregnancy are unclear

Our results highlight the urgency of prevention measures including COVID-19 vaccination during pregnancy

Learn More – Primary Sources:

Increasing severity of COVID-19 in pregnancy with Delta (B.1.617.2) variant surge

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