Prevalence, clinical features, and outcomes of SARS-CoV-2 infection in pregnant women with or without mild/moderate symptoms: Results from universal screening in a tertiary care center in Mexico City, Mexico

Abstract

The perinatal consequences of SARS-CoV-2 infection are still largely unknown. This study aimed to describe the features and outcomes of pregnant women with or without SARS-CoV-2 infection after the universal screening was established in a large tertiary care center admitting only obstetric related conditions without severe COVID-19 in Mexico City. This retrospective case-control study integrates data between April 22 and May 25, 2020, during active community transmission in Mexico, with one of the highest COVID-19 test positivity percentages worldwide. Only pregnant women and neonates with a SARS-CoV-2 result by quantitative RT-PCR were included in this study. Among 240 pregnant women, the prevalence of COVID-19 was 29% (95% CI, 24% to 35%); 86% of the patients were asymptomatic (95% CI, 76%-92%), nine women presented mild symptoms, and one patient moderate disease. No pregnancy baseline features or risk factors associated with severity of infection, including maternal age > 35 years, Body Mass Index >30 kg/m2, and pre-existing diseases, differed between positive and negative women. The median gestational age at admission for both groups was 38 weeks. All women were discharged at home without complications, and no maternal death was reported. The proportion of preeclampsia was higher in positive women than negative women (18%, 95% CI, 10%-29% vs. 9%, 95% CI, 5%-14%, P<0.05). No differences were found for other perinatal outcomes. SARS-CoV-2 test result was positive for nine infants of positive mothers detected within 24h of birth. An increased number of infected neonates were admitted to the NICU, compared to negative neonates (44% vs. 22%, P<0.05) and had a longer length of hospitalization (2 [2–18] days vs. 2 [2–3] days, P<0.001); these are potential proxies for illness severity. This report highlights the importance of COVID-19 detection at delivery in pregnant women living in high transmission areas.

COVID-19 in pregnancy, management and outcomes among pregnant women and neonates — results from tertiary care center in Wroclaw

“…SARS-CoV-2 infection in pregnancy seems to be associated with increased risks of preeclampsia, stillbirth, preterm birth, premature rupture of membrane and NICU admission. In the Cardona-Pérez et al study, an increased risk of preeclampsia in women with SARS-CoV-2 infection was found [16]. In our study group, only one woman (0.01% of respondents) was suspected of having pre-eclampsia, which does not allow us to confirm the conclusion of quoted Cardona-Pérez et al [16] the thesis that SARS-CoV-2 infection increases the risk of pre-eclampsia.…”

“…In the Cardona-Pérez et al study, an increased risk of preeclampsia in women with SARS-CoV-2 infection was found [16]. In our study group, only one woman (0.01% of respondents) was suspected of having pre-eclampsia, which does not allow us to confirm the conclusion of quoted Cardona-Pérez et al [16] the thesis that SARS-CoV-2 infection increases the risk of pre-eclampsia. In this study, also increased risk of premature rupture of membrane (PROM) was reported.…”

“…Indications for CS among COVID-19 positive women were firstly, solely maternal (40%) then fetal (31%) and lastly obstetrical (18%). CS rate in our hospital reached 68.7%, among which elective CS was performed in 10,5%, urgent/emergency due to maternal or fetal indications 89,5%; due to worsening COVID-19 disease 19.3% [16].…”

“…The average caesarean section rate in Italian study (Donati et al [15]) was 33.7%; elective CS was performed in 15.4% of the cases; urgent/emergency CS due to maternal or fetal indications was performed in 15% and due to COVID-19 was performed in 3.3% of the cases. In another study conducted in Mexico City (Cardona-Perez et al [16]) CS rate reached 81% among SARS-CoV-2 positive women comparing to non-infected pregnant women (73%). Indications for CS among COVID-19 positive women were firstly, solely maternal (40%) then fetal (31%) and lastly obstetrical (18%).…”

COVID-19 Infection in Pregnancy: PCR Cycle Thresholds, Placental Pathology, and Perinatal Outcomes

“…This large referral center for perinatal health care has one of the highest prevalences of SARS-CoV-2 among pregnant women, around 30%. However, less than 3% of patients were symptomatic [ 13 , 14 ]. The mild to moderate symptoms associated with SARS-CoV-2 infection were headache, dyspnea, myalgia, and olfactory/gustatory dysfunction [ 13 ].…”