COVID-19 linked to ICU admission during pregnancy, preterm birth

Pregnant and recently pregnant women with COVID-19 are less likely than nonpregnant women of reproductive age to have fever and myalgia but may be more likely to be admitted to the ICU, according to a study published in BMJ.

The results also showed that pregnant women with COVID-19 are more likely to experience preterm birth than those without COVID-19.

“Pregnant women are considered a high-risk group because of concerns about the effect of COVID-19 on them during and after pregnancy, and on their neonates,” John Allotey, MSc, PhD, senior research fellow in epidemiology and women's health at the University of Birmingham, United Kingdom, and colleagues wrote. “Quantification of the rates of COVID-19, its risk factors, clinical manifestations and outcomes is key to planning clinical maternal care and management in an evolving pandemic scenario.”

Allotey and colleagues conducted a living systematic review and meta-analysis of studies on COVID-19 in pregnant women from multiple databases published from December 1 through June 26.

They included studies that compared rates of COVID-19, clinical manifestations of the disease, risk factors and associated mortality and morbidity among pregnant, recently pregnant and nonpregnant women of reproductive age. They also included studies that compared both maternal and perinatal outcomes between pregnant women with and without COVID-19.

After exclusions and removing duplicates, 77 studies were included in the final analysis. Of those, 26 (34%) were from the United States and 24 (31%) were from China.

All studies confirmed SARS-CoV-2 infection using respiratory samples tested with RT-PCR; 23 studies diagnosed COVID-19 through clinical suspicion.

Allotey and colleagues determined that 10% (95% CI; 7%-14%; 28 studies, 11,432 women) of pregnant or recently pregnant women who were admitted to the hospital were diagnosed with confirmed or suspected COVID-19.

They found that among pregnant women, the most common clinical manifestations of the novel coronavirus were fever (40%) and cough (30%). However, women who were pregnant or recently pregnant were less likely to report symptoms of fever (OR = 0.43, 95% CI; 0.22-0.85; I2=74%; 5 studies; 80,521 women) and myalgia (OR = 0.48; 0.45-0.51; I2=0%; 3 studies; 80,409 women) compared with women of reproductive age who were not pregnant.

In addition, they found that women with COVID-19 who were pregnant or recently pregnant were more likely to need ICU admission (OR = 1.62; 1.33-1.96; I2=0%)) and invasive ventilation (OR = 1.88; 1.36 to 2.60; I2=0%; 4 studies, 91 606 women) compared with women who were not pregnant.

Severe COVID-19 in pregnancy, according to the researchers, was associated with older age in mothers (OR = 1.78; 95% CI, 1.25-2.55; 4 studies; 1058 women), high BMI (OR = 2.38; 95% CI, 1.67-3.39; 3 studies; 877 women), chronic hypertension (OR = 2.0; 95% CI, 1.14 -3.48; 2 studies; 858 women) and pre-existing diabetes (OR = 2.51; 95% CI, 1.31-4.80; 2 studies; 858 women).

Allotey and colleagues reported that pre-existing comorbidities were risk factors for ICU admission (OR = 4.21; 95% CI, 1.06-16.72; 2 studies; 320 women) and ventilation (OR = 4.48; 95% CI, 1.40-14.37; 2 studies; 313 women).

They also found that compared with pregnant women without COVID-19, the odds of preterm birth were higher in pregnant women with COVID-19 (OR = 3.01; 95% CI, 1.16 to 7.85; 2 studies; 339 women).

“Clinicians will need to balance the need for regular multidisciplinary antenatal care to manage women with pre-existing comorbidities against unnecessary exposure to the virus, through virtual clinic appointments when possible,” Allotey and colleagues wrote.

They added that additional studies are needed, and that their living systematic review and meta-analysis, which will have regular search and analysis updates, “is ideally placed to assess the impact of new findings on the rapidly growing evidence base.”