Predictors of severe and critical disease in pregnant women with SARS-CoV-2

Abstract

Background/Objective SARS-CoV-2 continues to spread widely in the US and worldwide. Pregnant women are more likely to develop severe or critical illness than their non-pregnant counterparts. Known risk factors for severe and critical disease outside of pregnancy, such as asthma, diabetes, and obesity have not been well-studied in pregnancy. We aimed to determine which clinical and pregnancy-related factors were associated with severe and critical COVID illness in pregnancy. Study design This was a retrospective cohort study of women with confirmed intrauterine pregnancy and positive nasopharyngeal swab for SARS-CoV-2 who presented to an academic medical center in New York City from 1 March 2020 to 1 July 2020. Severe and critical COVID-19 disease was defined by World Health Organization criteria. Women with severe/critical disease were compared to women with asymptomatic/mild disease. Continuous variables were compared with Mann–Whitney or t -test and categorical variables were compared using chi-square and Fisher’s exact. Statistical significance was set at p < .05. Multivariable logistic regression was performed including variables that were significantly different between groups. Results Two hundred and thirty-three patients were included, 186 (79.8%) with asymptomatic/mild disease and 47 (20.2%) with severe/critical disease. Women with asymptomatic/mild disease were compared to those with severe/critical disease. Women with severe/critical disease were more likely to have a history of current or former smoking (19.6 vs. 5.4%, p = .004), COVID-19 diagnosis in the 2nd trimester (42.6 vs. 11.8%, p = .001), and asthma or other respiratory condition (21.3 vs. 7.0%, p = .01). Women with severe/critical disease were more likely to have cesarean delivery (35.5 vs. 15.6%, p < .01) and preterm delivery <37 weeks (25.8 vs. 3.8%, p < .01). After adjustment, history of smoking remained significantly predictive of severe/critical disease [aOR 3.84 (95% CI, 1.25–11.82)]. Conclusion Pregnant women with a history of smoking, asthma, or other respiratory condition, and COVID-19 diagnosis in the second trimester of pregnancy were more likely to develop severe/critical disease. These findings may be useful in counseling women on their individual risk of developing the severe or critical disease in pregnancy and may help determine which women are good candidates for vaccination during pregnancy.

Brixia Score in Outcomes of Alpha versus Delta Variant of Infection in Pregnant Critical COVID-19 Patients

“…Still, as stated above, less than half of the patients infected with the Delta variant (group 2) delivered preterm when critically ill, and the rest continued their pregnancy normally; this was significantly different from group 1, in which almost all patients delivered preterm. This is partly in accordance with what was reported by Limaye [50]: women with severe/critical disease were more likely to have cesarean delivery (35.5%) or preterm delivery <37 weeks (25.8%). We report 77.78 and 100% of deliveries by cesarean section in the two groups, respectively, and preterm delivery at 32 and 34 weeks for most patients in group 1, but for less than half of the patients in group 2.…”

Global Perspectives on Immunization Against SARS-CoV-2 During Pregnancy and Priorities for Future Research: An International Consensus Paper From the World Association of Infectious Diseases and Immunological Disorders

“…Sociodemographic and clinical risk factors associated with poor outcomes have been identified through pregnancy cohorts worldwide. Women from Black, Asian and other ethnic minority backgrounds, maternal age >35 years, women who are overweight or obese, those with a history of smoking and women with co-morbidities such as hypertension or diabetes are at increased risk of developing severe COVID-19 ( 11 , 15 – 17 ).…”

COVID-19 in Pregnancy: Influence of Body Weight and Nutritional Status on Maternal and Pregnancy Outcomes—A Review of Literature and Meta-Analysis

“…Pooled data show a statistically significant excess of risk of having critical/severe disease for obese (BMI >= 30) pregnant women (OR = 2.32 [1.65–3.25]; I 2 = 57%; based on eight studies) [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] ( Figure 2 ).…”

“… BMI >= 30 vs. BMI < 30—disease severity (critical/severe vs. mild) [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. …”

“…BMI >= 30 vs. BMI < 30 –. [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. ( D ) Sensitivity analysis including only good quality studies—Maternal death.…”