Coronavirus disease 2019 in pregnancy

Abstract

This study aimed to compare clinical courses and outcomes between pregnant and reproductive-aged non-pregnant women with COVID-19, and to assess the vertical transmission potential of COVID-19 in pregnancy. Methods: Medical records of pregnant and reproductive-aged non-pregnant women hospitalized with COVID-19 from January 15 to March 15, 2020 were retrospectively reviewed. The severity of disease, virus clearance time, and length of hospital stay were measured as the primary objective, while the vertical transmission potential of COVID-19 was also assessed. Results: Eighty-two patients (28 pregnant women, 54 reproductive-aged non-pregnant women) with laboratory-confirmed COVID-19 were enrolled in this study. Univariate regression indicated no association between pregnancy and severity of disease (OR 0.73, 95% CI 0.08-5.15; p = 0.76), virus clearance time (HR 1.16, 95% CI 0.65-2.01; p = 0.62), and length of hospital stay (HR 1.10, 95% CI 0.66-1.84; p = 0.71). Of the pregnant women, 22 delivered 23 live births, either by cesarean section (17, 60.7%) or vaginal delivery (5, 17.9%), and no neonate was infected with SARS-CoV-2. Conclusions: Pregnant women have comparable clinical courses and outcomes with reproductive-aged non-pregnant women when infected with SARS-CoV-2. No evidence supported vertical transmission of COVID-19 in the late stage of pregnancy, including vaginal delivery.

Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS‐CoV‐2 infection among hospitalized pregnant women: A systematic review

“…Serum biochemistry results were reported in 37 studies encompassing 381 women respectively 4,5,9–11,13–15,17,18,20,21,25,29,30,33–36,39,41,44–50,53,56,57–60,63,66 . In this group, raised serum C‐reactive protein was reported among 275 (72.2%) women, lymphopenia among 179 (47.0%) women, and transaminitis among 93 (24.4%) women.…”

“…Miscarriage or termination of pregnancy was reported in six studies 32–34,53,54,63 . In total, there were seven miscarriages five in the first trimester, and two in the second trimester.…”

“…Seven (1.9%) women were aged 40 years or older. Presenting symptoms were reported in 55 studies, comprising 515 pregnant women 4,5,7,11–19,21–30,32–57 . Of these, the most common symptoms at presentation were fever (n=273, 53.0%), cough (n=224, 43.5%), myalgia/malaise (n=79, 15.3%), dyspnea (n=64, 12.4%), diarrhea (n=18, 3.5%), and sore throat (n=18, 3.5%), regardless of gestational age.…”

“…There were no pre‐existing risk factors associated with second‐trimester miscarriage. Moreover, a further nine women in the first and second trimester chose to undergo termination of pregnancy due to anxiety about potential adverse pregnancy outcomes caused by COVID‐19 infection in early pregnancy, or concerns about adverse effects from medication and radiological examinations 33,53,62 …”

Severe maternal morbidity and mortality associated with COVID‐19: The risk should not be downplayed

“…Published case series from China have not reported any maternal deaths related to COVID-19. 1,2,3 However, maternal mortalities associated with COVID-19 have been reported recently from several other countries in mainstream news and social media (https://ripetomato.org/2020/04/05/covid-19-in-pregnancy-news-reports/) as well as in the scientific literature. 8,9 The Public Health Agency of Sweden has also reported one maternal death, which was not included in the data analysis of pregnant women admitted to intensive care.…”