Clinical Impact of COVID-19 in Pregnancy

Introduction

Pregnancy increased the risk of pneumonia, mechanical ventilation, acute respiratory distress syndrome and death during the H1N1 influenza pandemic in the past. However, COVID-19 outbreak seems to have fewer adverse maternal and neonatal outcomes in pregnant women. The clinical course and outcomes between pregnant and non-pregnant women infected with SARS-CoV-2 has not been compared before.

Aim

This study compared the clinical course and outcomes in pregnant and non-pregnant women with COVID-19 and also evaluated the vertical transmission of COVID-19.

Method

Study Design

• Retrospective observational study

Treatment Strategy

• Pregnant and reproductive-aged (18-41 years old) non-pregnant women hospitalized with COVID-19
• Data such as age, comorbidities, time from onset of symptoms to hospital admission, severity of COVID-19, virus clearance time, length of hospital stay (LOS), symptoms at onset, vital signs on admission, laboratory tests, computed tomography (CT) findings and treatments was recorded
• In case of pregnant women, gestational age on admission, outcome of pregnancy, neonatal outcomes and perinatal complications were recorded

End Point

• Severity of COVID-19 disease
• Virus clearance time
• LOS
• Vertical transmission potential of COVID-19

Results

• The overall cohort comprised 82 women; 28 were pregnant and 54 were non-pregnant, with mean age of 30 and 31 years, respectively
• Comorbidities were not frequently reported in both the groups
• The duration from symptom onset to hospital admission was shorter in pregnant women; p<0.001
• Both the groups had comparable severity
• There were no significant associations between pregnancy and virus clearance time (HR 1.16; p = 0.62), LOS (HR 1.10; p = 0.71), and severity of disease (OR 0.73; p = 0.76)
• Of the pregnant women, 22 delivered 23 live births, 60.7% by cesarean section and 17.9% by vaginal delivery
• There were no neonatal deaths, neonatal asphyxia or fetal deaths
• None of the neonates were infected with SARS-CoV-2

Conclusion

• The pregnant and reproductive aged non-pregnant women infected with SARS-CoV-2 had comparable clinical course and outcomes.
• The results of the study demonstrated no associations between pregnancy and severity of COVID-19, virus clearance time, and length of hospital stay
• There was no evidence supporting vertical transmission of COVID-19 in the late stages of pregnancy, including vaginal delivery. However, due to the limited data, the potential for vertical transmission is still uncertain and warrants further study.

Int J Infect Dis. 2020 June:376-83.