“Clinical characteristics, symptoms, management and health outcomes in 8,598 pregnant women diagnosed with COVID-19 compared to 27,510 with seasonal influenza in France, Spain and the US: a network cohort analysis”

Abstract

OBJECTIVES: To describe comorbidities, symptoms at presentation, medication use, and 30-day outcomes after a diagnosis of COVID-19 in pregnant women, in comparison to pregnant women with influenza. DESIGN: Multinational network cohort SETTING: A total of 6 databases consisting of electronic medical records and claims data from France, Spain, and the United States. PARTICIPANTS: Pregnant women with ≥ 1 year in contributing databases, diagnosed and/or tested positive, or hospitalized with COVID-19. The influenza cohort was derived from the 2017-2018 influenza season. OUTCOMES: Baseline patient characteristics, comorbidities and presenting symptoms; 30-day inpatient drug utilization, maternal complications and pregnancy-related outcomes following diagnosis/hospitalization. RESULTS: 8,598 women diagnosed (2,031 hospitalized) with COVID-19 were included. Hospitalized women had, compared to those diagnosed, a higher prevalence of pre-existing comorbidities including renal impairment (2.2% diagnosed vs 5.1% hospitalized) and anemia (15.5% diagnosed vs 21.3% hospitalized). The ten most common inpatient treatments were systemic corticosteroids (29.6%), enoxaparin (24.0%), immunoglobulins (21.4%), famotidine (20.9%), azithromycin (18.1%), heparin (15.8%), ceftriaxone (7.9%), aspirin (7.0%), hydroxychloroquine (5.4%) and amoxicillin (3.5%). Compared to 27,510 women with influenza, dyspnea and anosmia were more prevalent in those with COVID-19. Women with COVID-19 had higher frequency of cesarean-section (4.4% vs 3.1%), preterm delivery (0.9% vs 0.5%), and poorer maternal outcomes: pneumonia (12.0% vs 2.7%), ARDS (4.0% vs 0.3%) and sepsis (2.1% vs 0.7%). COVID-19 fatality was negligible (N<5 in each database respectively). CONCLUSIONS: Comorbidities that were more prevalent with COVID-19 hospitalization (compared to COVID-19 diagnosed) in pregnancy included renal impairment and anemia. Multiple medications were used to treat pregnant women hospitalized with COVID-19, some with little evidence of benefit. Anosmia and dyspnea were indicative symptoms of COVID-19 in pregnancy compared to influenza, and may aid differential diagnosis. Despite low fatality, pregnancy and maternal outcomes were worse in COVID-19 than influenza.

Characteristics, outcomes, and mortality amongst 133,589 patients with prevalent autoimmune diseases diagnosed with, and 48,418 hospitalised for COVID-19: a multinational distributed network cohort analysis

“…(31) In pregnant women, there was a higher frequency of Caesarean section and preterm deliveries, as well as poorer outcomes (pneumonia, ARDS, sepsis, acute kidney injury, and cardiovascular and thromboembolic events) in those diagnosed with COVID-19 in comparison with seasonal influenza. (32) Like the other databases, CUIMC showed higher mortality in hospitalized patients with COVID-19 than those with influenza, but it showed lower complications in patients hospitalized with COVID-19 than influenza. A possible explanation is that patients hospitalized with influenza had higher incidence of co-morbidities like COPD and type 2 diabetes, which was also found in a previous study (33), or that data were not well captured during the height of the pandemic.…”

Unraveling COVID-19: A Large-Scale Characterization of 4.5 Million COVID-19 Cases Using CHARYBDIS

“…We found similarities in comorbidities and presenting symptoms. The large, diverse sample size allows also for the identification of populations of great interest, including children and adolescents, 25 pregnant women, 26 patients with a history of cancer, 27 patients with a history of autoimmune disorders, 28 or patterns of drug utilization in COVID-19 treatment, 21 and which were the focus of additional in-depth investigations.…”

“…The large, diverse sample size allows for extensive investigation on subgroups of interest. CHARYBDIS is the framework for additional in-depth investigations on children and adolescents, 25 pregnant women, 26 patients with a history of cancer, 27 patients with a history of autoimmune disorders, 21 or patterns of drug utilization in COVID-19 treatment. 21 The size of these results are so large, we have hundreds combinations of subgroups of interest that remain unreported.…”

No evidence of fetal defects or anti-syncytin-1 antibody induction following COVID-19 mRNA vaccination

“…Pregnant women are at increased risk for severe coronavirus disease 2019 (COVID- 19) with higher rates of hospitalization, intensive care, and death compared to nonpregnant women [1][2][3][4][5][6][7]. However, pregnant women were not included in the initial COVID-19 vaccine trials, leading to a lack of data on vaccine-associated benefits or adverse events in this population [8].…”