tetano
Editor, Senior Moderator
Am J Obstet Gynecol MFM
. 2022 Apr 6;100636.
doi: 10.1016/j.ajogmf.2022.100636. Online ahead of print.
Severe maternal morbidity in pregnant patients with severe acute respiratory syndrome coronavirus 2 infection
Moti Gulersen[SUP] 1 [/SUP], Burton Rochelson[SUP] 2 [/SUP], Weiwei Shan[SUP] 3 [/SUP], Cara S Wetcher[SUP] 2 [/SUP], Michael Nimaroff[SUP] 2 [/SUP], Matthew J Blitz[SUP] 4 [/SUP]
Affiliations
Abstract
Background: While the increased risk of severe illness and adverse pregnancy outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy are well described, the association of infection with severe maternal morbidity (SMM) has not been well characterized.
Objective: To evaluate the risk of SMM associated with SARS-CoV-2 infection in pregnancy.
Study design: A multicenter retrospective cohort study of all pregnant patients who had SARS-CoV-2 testing and delivered in a New York health system between March 1[SUP]st[/SUP], 2020 and March 1[SUP]st[/SUP], 2021. Patients with missing test results were excluded. The primary outcome of SMM, derived from the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine example list of diagnoses and complications, was compared between two groups: patients who tested positive for SARS-CoV-2 during pregnancy versus patients who tested negative. Secondary outcomes included subgroups of SMM. Multivariable logistic regression was used to adjust for potential confounders such as maternal demographics, neighborhood socioeconomic status, hospital location, and pregnancy-related complications. A subanalysis was performed to determine whether the risk of severe obstetrical hemorrhage and hypertension/neurologic morbidity differed based on timing of SARS-CoV-2 infection: those who tested positive for SARS-CoV-2 at their delivery hospitalization (i.e. active infection), and those who tested positive during pregnancy but negative at their delivery hospitalization (i.e. resolved infection).
Results: Of the 22,483 patients included, 1,653 (7.4%) tested positive for SARS-CoV-2 infection. Patients with SARS-CoV2 infection were more commonly Black, multiracial, Hispanic, non-English speaking, using Medicaid insurance, multiparous, and from neighborhoods with a lower socioeconomic status. Patients with SARS-CoV-2 infection were at an increased risk of SMM compared to those without infection (9.3 vs. 6.5%; adjusted OR 1.52, 95% CI 1.21-1.88). Patients with SARS-CoV-2 infection were also at an increased risk of severe obstetrical hemorrhage (1.1% vs. 0.5%; aOR 1.78, 95% CI 1.04-2.88), pulmonary morbidity (2.0% vs. 0.5%; aOR 3.90, 95% CI 2.52-5.89), and intensive care unit (ICU) admission (1.8% vs. 0.5%; aOR 3.29, 95% CI 2.09-5.04) compared to those without infection. The risk of hypertension/neurologic morbidity was similar between the two groups. Timing of SARS-CoV-2 infection (whether active or resolved at time of delivery) was not associated with the risk of severe obstetrical hemorrhage or hypertension/neurologic morbidity compared to those without infection.
Conclusions: SARS-CoV-2 infection in pregnancy is associated with an increased risk of SMM, severe obstetrical hemorrhage, pulmonary morbidity, and ICU admission. These data highlight the need for obstetrical unit preparedness in caring for patients with SARS-CoV-2 infection, continued public health efforts aimed at minimizing risk of infection and support including this select population in investigational therapy and vaccine trials.
Keywords: COVID-19; ICU admission; SARS-CoV-2; obstetrical hemorrhage; pregnancy; severe maternal morbidity.
. 2022 Apr 6;100636.
doi: 10.1016/j.ajogmf.2022.100636. Online ahead of print.
Severe maternal morbidity in pregnant patients with severe acute respiratory syndrome coronavirus 2 infection
Moti Gulersen[SUP] 1 [/SUP], Burton Rochelson[SUP] 2 [/SUP], Weiwei Shan[SUP] 3 [/SUP], Cara S Wetcher[SUP] 2 [/SUP], Michael Nimaroff[SUP] 2 [/SUP], Matthew J Blitz[SUP] 4 [/SUP]
Affiliations
- PMID: 35398348
- DOI: 10.1016/j.ajogmf.2022.100636
Abstract
Background: While the increased risk of severe illness and adverse pregnancy outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy are well described, the association of infection with severe maternal morbidity (SMM) has not been well characterized.
Objective: To evaluate the risk of SMM associated with SARS-CoV-2 infection in pregnancy.
Study design: A multicenter retrospective cohort study of all pregnant patients who had SARS-CoV-2 testing and delivered in a New York health system between March 1[SUP]st[/SUP], 2020 and March 1[SUP]st[/SUP], 2021. Patients with missing test results were excluded. The primary outcome of SMM, derived from the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine example list of diagnoses and complications, was compared between two groups: patients who tested positive for SARS-CoV-2 during pregnancy versus patients who tested negative. Secondary outcomes included subgroups of SMM. Multivariable logistic regression was used to adjust for potential confounders such as maternal demographics, neighborhood socioeconomic status, hospital location, and pregnancy-related complications. A subanalysis was performed to determine whether the risk of severe obstetrical hemorrhage and hypertension/neurologic morbidity differed based on timing of SARS-CoV-2 infection: those who tested positive for SARS-CoV-2 at their delivery hospitalization (i.e. active infection), and those who tested positive during pregnancy but negative at their delivery hospitalization (i.e. resolved infection).
Results: Of the 22,483 patients included, 1,653 (7.4%) tested positive for SARS-CoV-2 infection. Patients with SARS-CoV2 infection were more commonly Black, multiracial, Hispanic, non-English speaking, using Medicaid insurance, multiparous, and from neighborhoods with a lower socioeconomic status. Patients with SARS-CoV-2 infection were at an increased risk of SMM compared to those without infection (9.3 vs. 6.5%; adjusted OR 1.52, 95% CI 1.21-1.88). Patients with SARS-CoV-2 infection were also at an increased risk of severe obstetrical hemorrhage (1.1% vs. 0.5%; aOR 1.78, 95% CI 1.04-2.88), pulmonary morbidity (2.0% vs. 0.5%; aOR 3.90, 95% CI 2.52-5.89), and intensive care unit (ICU) admission (1.8% vs. 0.5%; aOR 3.29, 95% CI 2.09-5.04) compared to those without infection. The risk of hypertension/neurologic morbidity was similar between the two groups. Timing of SARS-CoV-2 infection (whether active or resolved at time of delivery) was not associated with the risk of severe obstetrical hemorrhage or hypertension/neurologic morbidity compared to those without infection.
Conclusions: SARS-CoV-2 infection in pregnancy is associated with an increased risk of SMM, severe obstetrical hemorrhage, pulmonary morbidity, and ICU admission. These data highlight the need for obstetrical unit preparedness in caring for patients with SARS-CoV-2 infection, continued public health efforts aimed at minimizing risk of infection and support including this select population in investigational therapy and vaccine trials.
Keywords: COVID-19; ICU admission; SARS-CoV-2; obstetrical hemorrhage; pregnancy; severe maternal morbidity.