Table 1.
Illness Severity and Perinatal Outcomes of Patients Who Required Delivery During Their Admission With Coronavirus Disease 2019 (COVID-19), According to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variant Type
| Period |
P | RR (95% CI) | aRR (95% CI)* | ||
|---|---|---|---|---|---|
| Pre-Delta (n=224) |
Delta (n=69) |
||||
| Disease severity† | <.001 | ||||
| Asymptomatic | 104 (46) | 11 (16) | 0.34 (0.20–0.60) | 0.34 (0.19–0.59) | |
| Mild–moderate | 91 (41) | 33 (48) | 1.18 (0.88–1.58) | 1.22 (0.90–1.65) | |
| Severe–critical | 29 (13) | 25 (36) | 2.80 (1.76–4.44) | 2.76 (1.73–4.40) | |
| ICU admission | 18 (8) | 20 (29) | <.001 | 3.61 (2.03–6.42) | 3.42 (1.91–6.11) |
| Received pharmacologic treatment‡ | 35 (16) | 25 (36) | <.001 | 2.32 (1.50–3.59) | 2.31 (1.49–3.59) |
| Required respiratory support§ | 29 (13) | 25 (36) | <.001 | 2.80 (1.76–4.44) | 2.76 (1.73–4.40) |
| Intubation | 12 (5) | 16 (23) | <.001 | 4.33 (2.15–8.70) | 4.18 (2.06–8.48) |
| ECMO | 3 (1) | 3 (4) | .15 | 3.25 (0.67–15.72) | — |
| VTE | 5 (2) | 2 (3) | .67 | 1.30 (0.26–6.55) | — |
| Maternal death | 1 (1) | 1 (2) | .42 | 3.25 (0.21–51.22) | — |
| Patients who required delivery | n=91 | n=28 | |||
| Cesarean birth | 28 (31) | 17 (61) | .004 | 1.97 (1.29–3.03) | — |
| Indication, worsening maternal status | 4 (14) | 12 (71) | <.001 | 4.94 (1.90–12.88) | 4.94 (1.90–12.88) |
| Preterm birth at less than 37 wk | 30 (32) | 22 (73) | <.001║ | 2.37 (1.66–3.36) | 2.36 (1.68–3.32) |
| Gestational age at delivery (wk) | 35.6±5.6 | 33.7±4.8 | .14 | — | — |
| NICU admission | 37 (44) | 20 (74) | .008║ | 1.77 (1.23–2.53) | 1.77 (1.25–2.51) |
| Delivery complications | |||||
| Preeclampsia | 21 (23) | 5 (18) | .56 | 0.77 (0.32–1.86) | — |
| Abruption | 2 (2) | 1 (4) | .56¶ | 1.63 (0.15–17.26) | — |
| PPH | 10 (11) | 4 (14) | .74¶ | 1.30 (0.44–3.83) | — |
| Transfusion | 10 (11) | 4 (14) | .74¶ | 1.30 (0.44–3.83) | — |
| Stillbirth | 6 (6) | 1 (3) | .55║ | 0.53 (0.07–4.24) | — |
| Neonatal positive SARS-CoV-2 test result# | 0 (0) | 1 (4) | — | — | — |
RR, relative risk; aRR, adjusted relative risk; ICU, intensive care unit; ECMO, extracorporeal membrane oxygenation; VTE, venous thromboembolism; NICU, neonatal intensive care unit; PPH, postpartum hemorrhage; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Data are n (%) or mean±SD unless otherwise specified.
Adjusted relative risk (95% CI) with pre-Delta as reference, adjusted for asthma.
Disease severity based on the National Institutes of Health guidelines and categorized by the Metz et al study.1
Treatment includes azithromycin, cephalosporins, remdesivir, dexamethasone, or convalescent plasma.
Respiratory support included any form of supplemental oxygen (nasal cannula, high flow, bilevel positive airway pressure, and intubation).
Log-binomial regression models with repeated measures to account for correlation in data due to multiple gestations.
Fisher exact test.
Positive neonatal SARS-CoV-2 test result within 48 hours of delivery; placental studies in process to help determine whether this was a vertical transmission.