To the Editor:
Accurate data are essential to understand the potential consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. Until recently, no relevant or reliable data regarding potential adverse maternal outcomes were available. Thanks to Breslin and colleagues,1 we now know more about the maternal condition after coronavirus disease 2019 (COVID-19) infection during pregnancy. In their study, the authors initially assessed pregnant women presenting with symptoms, followed by systematic testing for every woman presenting to their maternity unit. Among 43 patients, 37 (86%) had mild clinical symptoms, 4 (9%) were considered as severe cases, and 2 others (5%) were admitted to the intensive care unit. The authors stated that these rates are likely similar to the general population: 81%, 14%, and 5% with mild, severe, and critical diseases, respectively, according to Wu and McGoogan.2
However, we should not compare apples and oranges. Pregnant women enrolled in the study by Breslin et al1 had a mean age of 29.7 years (standard deviation, 6.0). The age distribution of patients included in the study by Wu and McGoogan2 was significantly higher, with only 10% of patients under the age of 30 years (Figure ).
Figure.
Severity of cases and age distribution in the studies by Breslin et al1 and Wu and McGoogan2
Favre G. COVID-19 during pregnancy. AJOG MFM 2020.
Stating that pregnant women present with similar rates of adverse outcomes as a group of older patients would ignore one of the main cofactors known to contribute to severe and critical disease in SARS-CoV-2 infections. Comparing maternal complications with an older population afflicted with COVID-19 may critically underestimate the potential contribution of pregnancy as a risk factor. Moreover, the denominator in the study by Breslin et al1 included 6 asymptomatic patients, whereas other studies reported rates of adverse outcomes in patients diagnosed with COVID-19 after symptom onset. Therefore, the proportion of pregnant women exhibiting mild, severe, or critical COVID-19–related illness could be more significantly underestimated. Overall, pregnant women with COVID-19 infection should be treated with additional caution.3
Footnotes
This paper is part of a supplement that represents a collection of COVID-related articles selected for publication by the editors of AJOG MFM without additional financial support.
The authors report no conflict of interest.
References
- 1.Breslin N., Baptiste C., Gyamfi-Bannerman C., et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020;2 doi: 10.1016/j.ajogmf.2020.100118. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wu Z., McGoogan J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020 doi: 10.1001/jama.2020.2648. [Epub ahead of print] [DOI] [PubMed] [Google Scholar]
- 3.Favre G., Pomar L., Musso D., Baud D. 2019-nCoV epidemic: what about pregnancies? Lancet. 2020;395:e40. doi: 10.1016/S0140-6736(20)30311-1. [DOI] [PMC free article] [PubMed] [Google Scholar]