Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study

Abstract

ObjectivesTo describe a national cohort of pregnant women admitted to hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK, identify factors associated with infection, and describe outcomes, including transmission of infection, for mothers and infants.DesignProspective national population based cohort study using the UK Obstetric Surveillance System (UKOSS).SettingAll 194 obstetric units in the UK.Participants427 pregnant women admitted to hospital with confirmed SARS-CoV-2 infection between 1 March 2020 and 14 April 2020.Main outcome measuresIncidence of maternal hospital admission and infant infection. Rates of maternal death, level 3 critical care unit admission, fetal loss, caesarean birth, preterm birth, stillbirth, early neonatal death, and neonatal unit admission.ResultsThe estimated incidence of admission to hospital with confirmed SARS-CoV-2 infection in pregnancy was 4.9 (95% confidence interval 4.5 to 5.4) per 1000 maternities. 233 (56%) pregnant women admitted to hospital with SARS-CoV-2 infection in pregnancy were from black or other ethnic minority groups, 281 (69%) were overweight or obese, 175 (41%) were aged 35 or over, and 145 (34%) had pre-existing comorbidities. 266 (62%) women gave birth or had a pregnancy loss; 196 (73%) gave birth at term. Forty one (10%) women admitted to hospital needed respiratory support, and five (1%) women died. Twelve (5%) of 265 infants tested positive for SARS-CoV-2 RNA, six of them within the first 12 hours after birth.ConclusionsMost pregnant women admitted to hospital with SARS-CoV-2 infection were in the late second or third trimester, supporting guidance for continued social distancing measures in later pregnancy. Most had good outcomes, and transmission of SARS-CoV-2 to infants was uncommon. The high proportion of women from black or minority ethnic groups admitted with infection needs urgent investigation and explanation.Study registrationISRCTN 40092247.

Obstetrical and intensive care strategies in a high-risk pregnancy with critical respiratory failure due to COVID-19: a case report

“…We report a case of critical COVID-19 in a high-risk pregnancy, with acute respiratory failure requiring mechanical ventilation and premature termination of the pregnancy. Although pregnant women are not recognised as a vulnerable group for COVID-19, there is a growing body of evidence linking late pregnancy and prior maternal risk factors such as high BMI, diabetes and hypertension to adverse pregnancy outcomes including maternal and neonatal deaths [1,2,5,6,7].…”

“…With a case morbidity of up to 3% [1] and mortality 1.2% [2] in pregnant women, the SARS-CoV-2 virus has exposed vulnerable groups in the society to an unprecedented global health crisis. Despite being more prone to viral infections, health agencies have struggled to identify pregnant women as a susceptible group in the general population [3,4].…”

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“…The likelihood of vertical transmission is low based on the United Kingdom Obstetric Surveillance System (UKOSS) interim study where six babies (2.5%) had a positive nasopharyngeal swab for SARS-CoV-2 within 12 hours of birth in severely affected hospitalised women. [29]. Hence, the risk of vertical transmission in mild or asymptomatic patients is likely to be lower than that.…”

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