COVID-19 in pregnancy – characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries

Abstract

Introduction Population-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and health care systems. Material and method This study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between March 1 and June 30, 2020 and had a positive SARS-CoV-2 PCR test 14 days or fewer prior to the admission. Cause of admission was classified as either obstetric or COVID-19 related. Results In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women needed hospital care due to COVID-19. The rate of admission due to COVID-19 was 0.4 per 1000 deliveries in Denmark, Finland, and Norway and 3.8 per 1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (P < 0.001) and had migrant background (P < 0.001) compared to the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Preterm delivery (n=12, 25%, P < 0.001) and cesarean delivery (n=21, 43,8%, P < 0.001) were more frequent in women with COVID-19 compared to the women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported. Conclusion The risk of admission due to severe COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the rates of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.

SARS‐CoV‐2 infection among hospitalised pregnant women and impact of different viral strains on COVID‐19 severity in Italy: a national prospective population‐based cohort study

“…As reported by other studies, [23][24][25][26][27][28] we confirmed that women who were obese and women with previous comorbidities were more likely to develop severe COVID-19 disease. Pregnant women from HMPCs were also significantly more likely to be hospitalised with severe pneumonia, probably because of their lower socio-economic status and possible through delays in accessing health services.…”

“…Unexpectedly, we did not record a significant increase in the rate of CS, as reported in many systematic reviews, 27,29,30 and in the UK and Northern Europe, [23][24][25] where usually the CS rates are lower compared with Italy. The ItOSS detected a higher rate of CS only among women affected by COVID-19 pneumonia, whereas the increase reported by UKOSS is irrespective of symptom status.…”

“…Kingdom Obstetric Surveillance System (UKOSS) and the Nordic Obstetric Surveillance Study (NOSS) detected an absolute low risk for hospital admission of pregnant women as a result of severe COVID-19 disease, and no increase in the stillbirth rate and in maternal and neonatal deaths. [23][24][25] In contrast, the passive surveillance conducted by the US Centers for Disease Control and Prevention (CDC) and the following meta-analysis, mainly built on CDC reporting, described a higher prevalence of severe COVID-19 disease among pregnant women and poor maternal and perinatal outcomes, compared with the ItOSS results. 26,27 These differences seem to be mostly related to the study design adopted.…”

Preterm birth rates were slightly lower in Denmark during the first year of the COVID‐19 pandemic compared with the previous 4 years

“…been shown that the risk of preterm birth and perinatal death may be increased in hospitalised pregnant women with COVID-19. 18 This was also found in a Nordic study that included data from Denmark, 19 but until October 2020, we have data that show that only a few pregnant women were admitted to Danish hospitals due to COVID-19. 20 Another study found that most of the preterm births in pregnant women with COVID-19 were iatrogenic.…”

Self-reported mental health status of pregnant women in Sweden during the COVID-19 pandemic: A cross-sectional survey

“…Total score of GAD7 ranges from 0 to 21, higher scores indicate a higher level of generalized anxiety. The total score of GAD7 will be further categorized into severity categories of minimal (0-4), mild (5)(6)(7)(8)(9), moderate (10)(11)(12)(13)(14), and severe (15)(16)(17)(18)(19)(20)(21) anxiety. In this study, we used the Swedish version of GAD7 , which has demonstrated excellent internal consistency in previous studies.…”