564 Comparison of clinical outcomes in pregnant women with and without COVID-19 based on disease severity

Abstract

OBJECTIVE:We sought to evaluate maternal and neonatal outcomes in women with differing COVID-19 severity (asymptomatic versus symptomatic) to those without COVID-19 infection. STUDY DESIGN: We conducted a multicenter retrospective cohort study of all pregnant women delivering at three hospitals in a large not-for-profit health care organization from March through July 2020. Coarsened exact matching was performed to match women with and without COVID-19 using maternal age, body mass index, gestational age at delivery, parity and institution of delivery. Women without COVID-19 infection was the reference group. The primary outcome was a composite of maternal complications: stillbirth, postpartum hemorrhage, intraamniotic infection, endometritis and ICU admission. Outcomes were examined by adjusted binomial logistic regression analysis incorporating matched weights. RESULTS: Of 2,714 women who delivered at the three hospitals, 122 (4.5%) women had COVID-19 in the pregnancy. After coarsened exact matching, the study cohort included 486 women, 55 (11.3%) asymptomatic women, 36 (7.4%) symptomatic women and 395 (81.3%) women without disease. Demographic data (Table 1) showed that more Hispanic women were diagnosed with COVID-19 disease and represented the largest proportion in both the symptomatic and asymptomatic groups. Although there was an increase in the maternal composite outcome in both asymptomatic and symptomatic women compared to COVID-19 negative women, this was not statistically significant (Table 2). When compared to COVID-19 negative women, symptomatic women are more likely to be diagnosed with intraamniotic infection ) and require ICU admission (aOR 31.9 [95% CI 2.9-344.8]. There were no statistically different neonatal outcomes. CONCLUSION: Women with symptomatic or asymptomatic COVID-19 infection does not lead to increased odds of overall maternal morbidity compared to women without COVID-19 in pregnancy. This can be considered reassuring information to share with women who are contemplating or are pregnant in the pandemic.

Impacto da infecção pelo SARS-CoV-2 nos resultados gestacionais e neonatais em gestantes acompanhadas no Hospital das Clínicas da Faculdade de Medicina e no Hospital Universitário da USP

“…A prevalência da infecção nessas pacientes não está bem definida e varia amplamente a depender do local e método de testagem 18 , mas um estudo que avaliou o rastreamento universal na gravidez descreveu positividade média de 5,3% 19 , o que se assemelharia à da população geral [20][21][22][23] . Porém, alguns autores sugerem que a frequência da infecção pode ser até 70% maior [24][25][26] , em especial, em gestantes pertencentes a minorias étnicas e portadoras de comorbidades e sintomáticas 24,[27][28][29][30][31][32][33] .…”

“…Entretanto, alguns autores não encontraram tais associações (28,74,90,(99)(100)(101) , mesmo quando foi considerada a ocorrência de sintomas [102][103][104][105][106] .…”