Risk factors for illness severity among pregnant women with confirmed SARS-CoV-2 infection – Surveillance for Emerging Threats to Mothers and Babies Network, 20 state, local, and territorial health departments, March 29, 2020 -January 8, 2021

Abstract

Background: Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk for severe illness compared with nonpregnant women. Data to assess risk factors for illness severity among pregnant women with COVID-19 are limited. This study aimed to determine risk factors associated with COVID-19 illness severity among pregnant women with SARS-CoV-2 infection. Methods: Pregnant women with SARS-CoV-2 infection confirmed by molecular testing were reported during March 29, 2020-January 8, 2021 through the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). Criteria for illness severity (asymptomatic, mild, moderate-to-severe, or critical) were adapted from National Institutes of Health and World Health Organization criteria. Crude and adjusted risk ratios for moderate-to-severe or critical COVID-19 illness were calculated for selected demographic and clinical characteristics. Results: Among 5,963 pregnant women with SARS-CoV-2 infection, moderate-to-severe or critical COVID-19 illness was associated with age 30-39 years, Black/Non-Hispanic race/ethnicity, healthcare occupation, pre-pregnancy obesity, chronic lung disease, chronic hypertension, cardiovascular disease, pregestational diabetes mellitus or gestational diabetes. Risk of moderate-to-severe or critical illness increased with the number of underlying medical or pregnancy-related conditions. Conclusions: Pregnant women with moderate-to-severe or critical COVID-19 illness were more likely to be older and have underlying medical conditions compared to pregnant women with asymptomatic infection or mild COVID-19 illness. This information might help pregnant women understand their risk for moderate-to-severe or critical COVID-19 illness and inform targeted public health messaging.

Infection and transmission of ancestral SARS-CoV-2 and its alpha variant in pregnant white-tailed deer

“…The effects of SARS-CoV-2 infection on pregnant women, the pregnancy, the fetus, and postpartum are still not fully understood. Several retrospective studies have shown pregnancy to be associated with higher risk of severe illness caused by COVID-19 as well as increased admissions to intensive care and neonatal units; also increased numbers of preterm births (under 37 weeks) have been observed during the course of the pandemic [28][29][30][31][32] . Still births and neonatal death appear to be relatively low for mothers independent whether they are infected or not with SARS-CoV-2 29 .…”

SARS-CoV-2 infections among neonates born to women with SARS-CoV-2 infection: maternal, pregnancy and birth characteristics

“…Future studies--that compare infected neonates to a representative sample of non-infected neonates--are needed to identify risk factors for neonatal SARS-CoV-2 infection and other neonatal adverse outcomes. Organization criteria as described in Galang et al 9 . Women were considered asymptomatic if reported as having an absence of symptoms using a symptom status variable rather than solely absence of individual symptoms reported.…”

“…For the current analysis, we describe neonates by SARS-CoV-2 testing. We focused on SARS-CoV-2 positive neonates and described maternal and birth characteristics, including maternal demographics, maternal COVID-19 disease severity 9 , timing of maternal infection relative to delivery (determined by date of rst positive SARS-CoV-2 or symptom onset, if testing date was missing) and pregnancy complications (e.g., preeclampsia). We assessed neonatal characteristics including gestational age and birthweight.…”

Impact of SARS‑CoV‑2 on pregnancy outcomes (Review)

“…In four cases, spontaneous delivery occurred and in the remaining cases, cesarean section was performed. according to the literature, cesarean section should be reserved for obstetrical indications (113)(114)(115)(116)(117). No case of neonatal infection with SarS-CoV-2 has yet been documented in Greece, at least to the best of our knowledge.…”

“…Currently, corticosteroids (prednisolone or hydrocortisone) and the antiviral drug, remdesivir, are used in pregnant women when they require oxygen alongside antithrombotic prophylaxis. as regards the use of remdesivir, the guidelines suggest not to withhold its use, unless otherwise indicated (116,117), while others suggest that its fetal safety profile is largely unknown (116). Preliminary data for vaccination against SarS-CoV-2 demonstrate no increase in adverse perinatal outcomes (117)(118)(119)(120)(121)(122)(123)(124).…”