Objective
To describe COVID-19 disease course in a multistate cohort of pregnant patients and evaluate whether more severe disease is associated with worse maternal and neonatal outcomes.
Study Design
Cohort of all pregnant patients with a singleton gestation and positive SARS-CoV-2 nucleic acid or antigen test (either in- or out-patient), who delivered at one of 33 U.S. hospitals from March 1 to July 31, 2020. Disease severity was classified by NIH criteria. Perinatal outcomes included death, cesarean delivery (CD), postpartum hemorrhage (PPH), hypertensive disorders of pregnancy (HDP), and preterm birth < 37 weeks’ (PTB). Centrally-trained perinatal research staff abstracted data from medical records. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling.
Results
1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe and 4% critical. Those with more severe illness had an older mean age, higher median body mass index, and higher frequency of medical comorbidities (asthma/COPD, diabetes, hypertension, liver disease, seizure disorder). The majority of included patients were Hispanic ethnicity; however, there was no trend in race-ethnicity distribution by severity (Table 1). The most common symptoms were cough (34%), dyspnea (19%), and myalgias (19%). Four maternal deaths (0.3%) were attributed to COVID-19. Adverse perinatal outcomes became more frequent with increasing severity of COVID-19, including a 6% (95% CI 2.5-10.9%) VTE rate with severe/critical (Table 2). In adjusted analyses, severe/critical COVID-19 was associated with CD, PPH, HDP, and PTB compared with asymptomatic patients. Approximately 1% (95% CI 0.5-1.8%) of neonates tested positive for SARS-CoV-2 before discharge.
Conclusion
Medical comorbidities were present more often in patients with more severe disease. Compared with asymptomatic patients, those with severe/critical COVID-19, but not those with mild/moderate COVID-19, were at increased risk of perinatal complications. Perinatal transmission was rare.
