Background Older age and medical comorbidities are identified risk factors for developing severe coronavirus disease 2019. However, there are limited data on risk stratification, clinical and laboratory course, and optimal management of coronavirus disease 2019 in pregnancy. Objective Our study aimed to describe the clinical course of coronavirus disease 2019, effect of comorbidities on disease severity, laboratory trends, and pregnancy outcomes of symptomatic and asymptomatic severe acute respiratory syndrome coronavirus 2–positive pregnant women. Study Design This is a case series of pregnant and postpartum women who received positive test results for severe acute respiratory syndrome coronavirus 2 between March 3, 2020, and May 11, 2020, within 3 hospitals of the Yale New Haven Health delivery network. Charts were reviewed for basic sociodemographic and prepregnancy characteristics, coronavirus disease 2019 course, laboratory values, and pregnancy outcomes. Results Of the 1567 tested pregnant and postpartum women between March 3, 2020, and May 11, 2020, 9% (n=141) had a positive severe acute respiratory syndrome coronavirus 2 result. Hispanic women were overrepresented in the severe acute respiratory syndrome coronavirus 2–positive group (n=61; 43.8%). In addition, Hispanic ethnicity was associated with a higher rate of moderate and severe diseases than non-Hispanic (18% [11/61] vs 3.8% [3/78], respectively; odds ratio, 5.5; 95% confidence interval, 1.46–20.7; P =.01). Of note, 44 women (31.2%) were asymptomatic, 37 of whom (26.2%) were diagnosed on universal screening upon admission for delivery. Moreover, 59% (n=83) were diagnosed before delivery, 36% (n=51) upon presentation for childbirth, and 5% (n=7) after delivery. Severe disease was diagnosed in 6 cases (4.3%), and there was 1 maternal death. Obese women were more likely to develop moderate and severe diseases than nonobese women (16.4% [9/55] vs 3.8% [3/79]; odds ratio, 4.96; 95% confidence interval, 1.28–19.25; P =.02). Hypertensive disorders of pregnancy were diagnosed in 22.3% of women (17/77) who delivered after 20 weeks’ gestation. Higher levels of C-reactive protein during antepartum coronavirus disease 2019–related admission were more common in women with worse clinical course; however, this association did not reach statistical significance. Conclusion Coronavirus disease 2019 in pregnancy may result in severe disease and death. Hispanic women were more likely to receive a positive test result for severe acute respiratory syndrome 2 than other ethnic groups. Obesity and Hispanic ethnicity represent risk factors for moderate and severe diseases.
Background: Penicillin allergy is the most commonly reported drug allergy in the United States, however less than 10% of individuals labeled with a penicillin allergy are truly allergic. A reported penicillin allergy in pregnancy is associated with adverse maternal and perinatal outcomes. Despite recommendations for penicillin allergy testing in pregnancy, limited literature regarding obstetric providers’ comfort and knowledge in addressing penicillin allergy and referral patterns exists. Objective: To survey obstetric providers to assess their clinical practice patterns and baseline penicillin allergy knowledge, identify potential knowledge gaps in management of pregnant patients with reported penicillin allergy, and measure the impact of an educational intervention on provider knowledge and practice patterns. Study Design: An anonymous, electronic 23 question survey administered to all obstetric providers at a single academic medical center assessed obstetric provider characteristics, self-reported antibiotic practice patterns, and antibiotic allergy knowledge before (June 19, 2020) and after (September 16, 2020) a penicillin allergy educational intervention, which consisted of multiple small-group educational sessions and a culminating departmental educational session. Discrete knowledge comparison by provider type and experience level was performed using chi square tests pre and post-intervention. Results: Of 277 obstetric providers invited, 124(45%) responded pre-intervention and 62(22%) post-intervention. 27% correctly identified the percentage of patients labeled penicillin allergic who would tolerate penicillins, 45% identified cephalosporin cross-reactivity, 59% understood penicillin allergies can wane, and 54% identified penicillin skin testing(PST) as a valid allergy verification tool. Among 48 respondents who attended educational sessions and responded post-intervention, their knowledge of penicillin allergy waning (79% pre-education vs 98% post-education, p<0.01) and PST as a valid tool for penicillin allergy verification (50% pre-education vs 83% post-education, p<0.01) improved. Conclusions: Knowledge gaps related to penicillin allergy exist among obstetric providers. Educational initiatives may improve provider knowledge, identification of patients requiring penicillin allergy evaluation, and reduce referral barriers.
Objective The impact of 2021 vaccination and social restriction reversal on preterm birth (PTB) is unclear. We sought to compare the rates of PTB during the COVID pre- and post- vaccination periods with pre-pandemic rate. Study Design Retrospective cohort comparing all deliveries over 20 weeks at a single tertiary center during ‘early’ (3/2020-6/2020) vs. ‘late’ COVID (3/2021–6/2021), and 'late' COVID vs. pre-COVID (3-6/2014-2019). PTB<37weeks, <34weeks and <28weeks were compared and stratified by race/ethnicity. Results 16483 deliveries occurred including 2068 ‘early’ COVID, 2115 ‘late’ COVID and 12300 pre-COVID. The PTB rate during ‘late’ COVID was lower compared to ‘early’ COVID (12.1% vs 14.6%,p=0.02). Rate of PTB<34 was also lower during ‘late’ COVID (4.4% vs 5.7%, p=0.05). PTB<28 did not differ. When controlling for prior PTB, ‘late’ COVID remained associated with a decreased risk of PTB compared to ‘early’ COVID, aOR 0.82 [95%CI:0.68,0.98]. Although there was no difference in PTB among Hispanic individuals when comparing ‘late’ COVID versus pre-COVID, when further sub-divided, a small number of Hispanic Puerto Rican(PR) individuals had higher odds of PTB<37 during late’ COVID versus pre-COVID (aOR:4.29 [95%CI 1.12,16.4]) (Table). Additionally, White individuals had reduced odds of PTB<37 (aOR 0.80[95%CI 0.65, 0.98]) during ‘late’ COVID versus pre-COVID while the PTB rate was unchanged when comparing ‘late’ COVID versus pre-COVID in all other racial and ethnic groups. Conclusion During 2021, PTB rates decreased from rates observed in 2020 at the height of COVID restrictions. Among White birthing individuals, PTB decreased in 2021 compared to pre-COVID rates. This decrease was not observed in Black and Hispanic birthing individuals. These data highlight the continued racially disparate impact of the COVID pandemic on PTB rates.
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