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Maternal Outcomes and Risk Factors for Severity Among Pregnant Women With COVID-19: A Case Control Study From the COVI-Preg International Registry

Publication date: 2020-01-01

Author:

Vouga, Manon
Favre, Guillaume ; Perez, Oscar Martinez ; Pomar, Leo ; Acebal, Laura Forcen ; Abascal, Alejandra ; Hernandez, Maria Rosa Vila ; Hcini, Najeh ; Lambert, Véronique ; Carles, Gabriel ; Sichitiu, Joanna ; Salomon, Laurent ; Stiremann, Julien ; Ville, Yves ; Tejada, Begoña Martinez de ; Goncé, Anna ; Hawkins-Villareal, Ameth ; Castillo, Karen ; Solsona, Eduard Gratacos ; Trigo, Lucas ; Cleary, Brian ; Geary, Michael ; Bartels, Helena ; Al-Kharouf, Feras ; Malone, Fergal ; Higgins, Mary ; Keating, Niamh ; Knowles, Susan ; Poncelet, Christophe ; Carvalho, Carolina ; Ribeiro-do-Valle, Fernanda ; Surita, Garanhani ; Dantas-Silva, Amanda ; Borrelli, Carolina ; Luz, Adriana Gomes ; Fuenzalida, Javiera ; Carvajal, Jorge ; Canales, Manuel Guerra ; Hernandez, Olivia ; Grechukhina, Olga ; Ko, Albert ; Reddy, Uma ; Figueiredo, Rita ; Moucho, Marina ; Pinto, Pedro Viana ; Luca, Carmen De ; Santis, Marco De ; Campos, Diogo Ayres de ; Garabedian, Charles ; Subtil, Damien ; Bohrer, Betania ; Oppermann, Maria Lucia Da Rocha ; Celeste, Maria ; Wender, Osorio ; Schuler-Faccini, Lavinia ; Sanseverino, Maria Teresa Vieira ; Giugliani, Camila ; Friedrich, Luciana ; Scherer, Mariana Horn ; Mottet, Nicolas ; Ducarme, Guillaume ; Pelerin, Helene ; Moreau, Chloe ; Breton, Bénédicte ; Quibel, Thibaud ; Rozenberg, Patrick ; Mueller, Doris ; Granado, Cristina ; Hoesli, Irene ; Monod, Cécile ; Bassler, Dirk ; Heldstab, Sandra ; Kölble, Nicole Ochsenbein ; Sentilhes, Loïc ; Charvet, Melissa ; Deprest, Jan ; Richter, Jute ; Veeken, Lennart Van der ; Eggel-Hort, Béatrice ; Plantefeve, Gaetan ; Derouich, Mohamed ; Calvache, Albaro José Nieto ; Lopez-Giron, Maria Camila ; Burgos-Luna, Juan Manuel ; Escobar-Vidarte, Maria Fernanda ; Hecher, Kurt ; Tallarek, Ann-Christin ; Hadar, Eran ; Haratz, Karina Krajden ; Malinger, Gustavo ; Maymon, Ron ; Yogev, Yariv ; Schäffer, Leonhard ; Toussaint, Arnaud ; Rossier, Marie-Claude ; sa, Renato Augusto Moreira de ; Grawe, Claudia ; Aebi-Popp, Karoline ; Radan, Anda-Petronela ; Raio, Luigi ; Surbek, Daniel ; Böckenhoff, Paul ; Strizek, Brigitte ; Kaufmann, Martin ; Bloch, Andrea ; Boulvain, Michel ; Johann, Silke ; Heldstab, Sandra Andrea ; Bernasconi, Monya Todesco ; Grant, Gaston ; Feki, Anis ; Brochut, Anne-Claude Muller ; Giral, Marylene ; Sedille, Lucie ; Papadia, Andrea ; Brugger, Romina Capoccia ; Weber, Brigitte ; Fischer, Tina ; Kahlert, Christian ; Saines, Karin Nielsen ; Cambou, Mary ; Kanellos, Panagiotis ; Chen, Xiang ; Yin, Mingzhu ; Haessig, Annina ; Baud, David ; Panchaud, Alice

Abstract:

Background: Recent evidence suggests that pregnant women might be at higher risk of severe disease associated with the emerging pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while exposed fetuses/newborns could suffer from preterm birth, growth restriction and neonatal infections. The magnitude of this increased risk and specific risk factors for severity remains unclear.

Methods: We performed a case control study comparing pregnant women with severe coronavirus disease 19 (case) to pregnant women with a milder form (controls) enrolled in COVI-Preg international registry cohort between from March 24 to July 26, 2020. Risk factors for severity, obstetrical, fetal and neonatal outcomes were assessed.

Findings: A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented a severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of cesarean sections [70.7% (n=53/75)], preterm deliveries [62.7% (n= 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n=31/75)].

Interpretation: Pregnant women, particularly those with associated comorbidities, seem to be at higher risk of severe complications of SARS-CoV-2 infection. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease; complications include cesarean sections, prematurity and neonatal admission to the intensive care unit.

Funding Statement: None.

Declaration of Interests: The authors declare that they have no conflicts of interest.

Ethics Approval Statement: The study was approved by both the Swiss Ethical Board (CER-VD- 2020-00548) and the local ethics boards at each participating center.