Relationship between coronavirus disease 2019 in pregnancy and maternal and fetal outcomes: Retrospective analytical cohort study

Abstract

Objective Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has caused many deaths and complications worldwide. However, limited data are available about COVID-19 during pregnancy. This study aimed to assess the epidemiological and clinical features of COVID-19, and the adverse maternal and fetal outcomes. Design This retrospective analytical cohort study was conducted on all pregnant women with confirmed COVID-19 at Nekouei-Hedayati-Forghani Hospital in Qom, Iran from 1 February 2019 to 15 September 2020. For the same period, 165 pregnant women who did not have COVID-19 were selected at random and included in this study. All epidemiological and clinical features were collected from the medical records of the participants. A logistic regression model was used to determine associations between COVID-19 in pregnancy and maternal and fetal outcomes. Findings The most common symptoms reported by pregnant women with COVID-19 were shortness of breath (60.9%), dry cough (59%) and fever (42.9%). After adjustment for potential confounding factors, COVID-19 in pregnancy was associated with a significantly higher risk of admission to the intensive care unit (ICU) [odds ratio (OR) 6.16, 95% confidence interval (CI) 1.23–31], caesarean section (OR 0.45, 95 CI 0.25–1.03), preterm birth (OR 3.01, 95% CI 1.4–6.54), fetal distress (OR 5.7, 95% CI 2.13–15.59) and admission to the neonatal intensive care unit (NICU) (OR 3.04, 95% CI 1.21–7.70). Key conclusions COVID-19 is associated with adverse maternal and fetal outcomes, including ICU admission, caesarean section, fetal distress, preterm birth and NICU admission.

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

“…This is in accordance with other studies in the Middle East as well as in other worldwide countries such as the United States ( Hirshberg et al, 2020 ) and China ( Chen H et al, 2020 ). In Iranian pregnant women, the most common reported symptoms of COVID-19 were fever, cough, and dyspnea ( Kazemi Aski et al, 2020 , 2021 ; Motlagh et al, 2020 ; Pirjani et al, 2020 ; Sattari et al, 2020 ; Akbarian-Rad et al, 2021 ; Alipour et al, 2021 ; Samadi et al, 2021 ; Vaezi et al, 2021 ; Vizheh et al, 2021 ; Abedzadeh-Kalahroudi et al, 2021b ). Lymphopenia and elevated C-reactive protein levels ( Pirjani et al, 2020 ; Akbarian-Rad et al, 2021 ; Vaezi et al, 2021 ; Abedzadeh-Kalahroudi et al, 2021a , b ), in addition to Elevated lactate dehydrogenase (LDH; Kazemi Aski et al, 2020 ; Abedzadeh-Kalahroudi et al, 2021a ), were the most common laboratory findings observed.…”

“…This in accordance with other studies conducted in the United States and the United Kingdom where it was found that hospitalized women with COVID-19 and have comorbidities, are more prone to severe illness ( Knight et al, 2020 ; Zambrano et al, 2020 ). Although the majority of the pregnant women with COVID-19 were hospitalized, a minority of ICU admissions and maternal death were observed ( Pirjani et al, 2020 ; Sattari et al, 2020 ; Alipour et al, 2021 ; Abedzadeh-Kalahroudi et al, 2021a ). The most common mode of delivery of infected pregnant women was a cesarean section, performed mostly under obstetric indication ( Pirjani et al, 2020 ; Alipour et al, 2021 ; Vaezi et al, 2021 ; Vizheh et al, 2021 ; Abedzadeh-Kalahroudi et al, 2021a ), rather than due to complications of COVID-19 ( Abedzadeh-Kalahroudi et al, 2021a ).…”

“…Although the majority of the pregnant women with COVID-19 were hospitalized, a minority of ICU admissions and maternal death were observed ( Pirjani et al, 2020 ; Sattari et al, 2020 ; Alipour et al, 2021 ; Abedzadeh-Kalahroudi et al, 2021a ). The most common mode of delivery of infected pregnant women was a cesarean section, performed mostly under obstetric indication ( Pirjani et al, 2020 ; Alipour et al, 2021 ; Vaezi et al, 2021 ; Vizheh et al, 2021 ; Abedzadeh-Kalahroudi et al, 2021a ), rather than due to complications of COVID-19 ( Abedzadeh-Kalahroudi et al, 2021a ). In one study only, it was found that the severity of the coronavirus disease was the only factor effective in increasing the rate of cesarean delivery ( Samadi et al, 2021 ).…”

“…Compared to pregnant women without COVID-19, those infected have lower gestational age ( Pirjani et al, 2020 ; Alipour et al, 2021 ), and higher rate of ICU admission ( Pirjani et al, 2020 ). Furthermore, it was reported that these latter have poorer maternal outcomes and higher rates of pre-eclampsia, preterm labor, and fetal distress ( Alipour et al, 2021 ; Abedzadeh-Kalahroudi et al, 2021a ). On the other hand, compared to non-pregnant infected women, pregnant women with COVID-19 have a lower frequency of severe disease, acute respiratory distress syndrome, and shorter mean duration of hospitalization ( Vizheh et al, 2021 ; Table 1 ).…”

“…Scattered reports however reported the transmission of the SARS-CoV-2 virus from the infected mother to her newborn ( Kamali Aghdam et al, 2020 ; Rashidian et al, 2020 ; Sattari et al, 2020 ; Zamaniyan et al, 2020 ; Abolhasan et al, 2021 ; Rabiei et al, 2021 ; Abedzadeh-Kalahroudi et al, 2021a ). According to several studies ( Alzamora et al, 2020 ; Penfield et al, 2020 ; Wu et al, 2020 ), it seems that vertical transmission increases when the mother experience a severe or critical course of the disease ( Alipour et al, 2021 ; Farhadi et al, 2021 ; Vizheh et al, 2021 ). Viral load in the infected mother may be another contributing factor for the vertical transmission ( Qiu et al, 2020 ; Fan et al, 2021 ).…”