Coronavirus disease 2019 pregnancy outcomes in a racially and ethnically diverse population

Abstract

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.

Smoking and risk of negative outcomes among COVID-19 patients: A systematic review and meta-analysis

“…The mean age of the patients in the included studies was 54.10 years. Nineteen studies defined outcomes as disease severity 22 , 27 – 30 , 37 – 39 , 42 , 43 , 46 – 50 , 58 , 60 , 62 , 63 . Seventeen studies defined outcomes as death 21 , 33 , 40 , 44 , 45 , 51 – 57 , 59 , 65 – 68 .…”

“…The important characteristics and outcomes of the included articles were collated (Table 1). Of 40 articles, 19 were conducted in China 21,22,27,29,30,[37][38][39][40][41][42][43][44][45][46][47][48][49][50] , one in Kuwait 26 , one in Korea 28 , one in Mexico 51 , one in Japan 52 , two in Spain 53,54 , three in Italy [55][56][57] , and twelve in the USA 33,[58][59][60][61][62][63][64][65][66][67][68] . Most articles were retrospective studies.…”

“…The mean age of the patients in the included studies was 54.10 years. Nineteen studies defined outcomes as disease severity 22,[27][28][29][30][37][38][39]42,43,[46][47][48][49][50]58,60,62,63 . Seventeen studies defined outcomes as death 21,33,40,44,45,[51][52][53][54][55][56][57]59,[65][66][67][68] .…”

“…Newcastle-Ottawa scale was used to assess the methodological quality of the 40 studies. Results showed 12 studies receiving ≥7 stars 26,44,49,[55][56][57][59][60][61][62]64,68 , and the remaining studies receiving <7 stars (Supplementary Table S2).…”

Learning Management Impacted with COVID-19 at Higher Education in Thailand: Learning Strategies for Lifelong Learning

“…The impacts of the coronavirus disease (COVID-19) situation have been described by a range of authors [1]- [8]. Thailand has been seriously affected in all spheres such as public health, economic, local livelihoods in the urban and regional setting, and social functioning which have disrupted the normal ways of communicating with one another [9].…”