Worse pregnancy outcomes with COVID-19 at delivery

Key takeaways :

• Pregnant patients with COVID-19 had a higher likelihood of severe maternal mortality compared with patients without.
• Over time, the COVID-19 case-fatality rate decreased from 232.9 to 79.1 per 100,000 deliveries.

Pregnant women with COVID-19 infection at delivery in the U.S. experienced substantial adverse outcomes early during the pandemic, researchers reported in JAMA Network Open.

“Several studies have examined outcomes before and during the pandemic periods. National-level data comparing pregnancy outcomes with and without COVID-19 infection are limited but are clinically compelling,” Koji Matsuo, MD, PhD, associate professor and chief of oncology research in the division of gynecologic oncology in the department of obstetrics and gynecology, Norris Comprehensive Cancer Center at the University of Southern California, Los Angeles, and colleagues wrote. “The objective of this study was to examine the patient characteristics and maternal outcomes associated with COVID-19 infection among pregnant patients at delivery during the early pandemic period in the United States.”

In this national-level analysis, researchers evaluated 2,578,095 hospital deliveries (median age, 29 years) from 2,691 centers between April and December 2020. The co-primary endpoints included patient characteristics associated with COVID-19 infection and severe maternal morbidity and mortality at delivery associated with COVID-19.

In the cohort, 5.7% of patients were Asian, 14.7% were Black, 20.6% were Hispanic and 50.7% were white. Over 9 months, 45,425 pregnant patients were diagnosed with COVID-19 at delivery and 63.3% of hospitals cared for them.

Researchers observed younger age, later study period, Black and Hispanic race or ethnicity, lower household income, obesity, medical comorbidity, homelessness status, Northeastern region, earlier gestational age and hospital admission to larger urban hospitals as characteristics associated with COVID-19 infection.

In addition, pregnant women with COVID-19 at delivery had a higher likelihood of developing severe maternal morbidity (46.4 vs. 18.8 per 1,000; adjusted OR = 2.6; 95% CI, 2.39-2.82) compared with those without COVID-19. Those with COVID-19 at delivery also had a 14 times higher mortality risk (64 vs. 4.3 per 100,000 deliveries; aOR = 13.91; 95% CI, 6.36-30.42) compared with those without. These patients also had an increase in failure-to-rescue risk (1.5% vs. 0.2%; aOR = 5.56; 95% CI, 2.51-12.3) compared with pregnant patients without COVID-19.

Researchers also noted a median time-to-death of 16 days among pregnant women with COVID-19 who died during hospitalization. The COVID-19 case-fatality rate decreased from 232.9 to 79.1 per 100,000 deliveries over time.

“The evaluation of the initial pandemic period in this study demonstrates the substantial morbidity and mortality of COVID-19 in pregnant patients and highlights the importance of prevention of COVID-19 in this population,” the researchers wrote. “Further investigation to assess the generalizability in the subsequent vaccine era is warranted.”