Pregnancy as a risk factor for severe coronavirus disease 2019 using standardized clinical criteria

Abstract

more than 11 million people have been infected with coronavirus disease 2019 and almost 250,000 people have died from the disease in the United States, less than 1 year since its discovery. Although literature is beginning to emerge on pregnancy as a risk factor for severe coronavirus disease 2019, these studies are heterogeneous and use primary outcomes such as intensive care unit admission or hospitalization as surrogate markers that may subject analyses to misclassification bias in pregnant patients. OBJECTIVE: This study aimed to determine the risk of severe coronavirus disease 2019 among pregnant women with symptomatic coronavirus disease 2019 compared with nonpregnant women using nonadmissionbased, standardized clinical criteria for severe disease. STUDY DESIGN: This is a retrospective cohort study of women aged 13 to 45 years and diagnosed as having symptomatic coronavirus disease 2019 between May 28, 2020, and July 22, 2020. The primary outcome was severe coronavirus disease 2019 as defined by 2 sets of nonadmission-based, clinical criteria: the World Health Organization Ordinal Scale for Clinical Improvement and the Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Adjusted risk ratios were estimated using multivariable logistic regression analyses. RESULTS: Of 262 women aged 13 to 45 years with symptomatic coronavirus disease 2019, 22 (8.4%) were pregnant and 240 (91.6%) were nonpregnant. After adjusting for covariates potentially associated with the primary outcome, symptomatic pregnant women were at a significantly increased risk of severe coronavirus disease 2019 compared with nonpregnant women using both the World Health Organization Ordinal Scale for Clinical Improvement (adjusted relative risk, 3.59; 95% confidence interval, 1.49−7.01) and Novel Coronavirus Pneumonia Emergency Response Epidemiology Team (adjusted relative risk, 5.65; 95% confidence interval, 1.36−17.31) criteria. CONCLUSION: Pregnancy significantly increases the risk of severe coronavirus disease 2019 as defined by nonadmission-based, clinical criteria.

Coronavirus disease 2019 (COVID-19) vaccination uptake among healthcare workers

“…Some subgroups remained reluctant in their willingness to vaccinate; such were female workers aged 20-40, whom many of these were pregnant or considered a pregnancy. It has been well demonstrated that COVID-19 infection in pregnancy is associated with an increased risk of adverse maternal obstetric complications [17], and pregnancy increases the risk of severe COVID-19 disease [18]. On the other hand pregnant people were excluded from the BNT162b2 mRNA Covid-19 vaccine clinical trials, and data regarding the safety of the vaccine in pregnancy at the time of our initial rollout was sparse [19].…”

Comparison of the pregnancy outcomes of the patients with severe symptoms who received medical treatment for COVID-19 versus the patients with mild-moderate symptoms

“…Comparison of the pregnancy outcomes of the patients with severe symptoms 3 due to the altered immune system during pregnancy. [10] In this study, we investigated symptomatic pregnant women who had mild-moderate and severe COVID-19 infection during pregnancy. We found gestational age at diagnosis of COVID-19 was higher in the severe patient group than the mild-moderate group (p=0.048) and there was no difference regarding pregnancy and neonatal outcomes between the severe and non-severe groups.…”

Mental health and substance use associated with hospitalization among people with laboratory confirmed diagnosis of COVID-19 in British Columbia: a population-based cohort study

“…Several biological studies have identified sex and age differences in biological pathways related to SARS-CoV-2 infection and support our findings. [20][21][22] Pregnancy has been previously identified as a potential risk factor for ICU admission 23,24 and severe disease, 25 but most studies have been limited to pregnant women who were already hospitalized (including for non-COVID-19 reasons such as childbirth). 23,26 This finding could be in part the result of a lower clinical threshold for hospitalization of pregnant patients.…”