Objective
Previous studies have suggested that coronavirus infectious disease 2019 (COVID-19) during pregnancy increases the rate of cesarean delivery (CD). We aimed to evaluate the mode of delivery (MOD) in patients with COVID-19 compared with negative controls, after adjusting for age, race/ethnicity, body mass index, and past medical history.
Study Design
We conducted a retrospective, multicenter case-control study to understand the association between COVID-19 in pregnancy and neonatal outcomes. We reviewed consecutive charts of adult females, ages 18-45, with laboratory-confirmed SARS-CoV-2 infection in six months between March 1, 2020, and August 31, 2020. Cases were patients diagnosed with COVID-19 during pregnancy [COVID (+)], whereas controls were pregnant patients who tested negative for COVID-19 [COVID (-)]. We excluded early pregnancy losses, termination of pregnancies, cases with multiple gestation or incomplete data. For cases delivered via CD, we reviewed if the delivery indication was COVID-19 related or not. We employed PSM to lessen the potential influence of confounding factors and increase the reliability of the results. The PSM was performed using age, race/ethnicity, body mass index, and past medical history (hypertension, cardiac disease, asthma, DM, venous thromboembolism). Analyses were performed with SAS software.
Results
A total of 2474 patients were identified, of which 2374 were COVID (-) and 100 COVID (+). After the PSM algorithm was applied, 388 patients remained in COVID (-) group and 97 in the COVID (+) group. Vaginal delivery was similar between COVID (+) and COVID (-) groups [ 68 (70.1%) vs 271(69.8%), p=1.0]. Further, there was no difference in rate of CD between COVID (+) and COVID (-) groups [29 (29.90%) vs 117 (30.15%), p = 1.0], nor significant increase in COVID related CD [3 (10.3%), p = 1.0].
Conclusion
Our results suggest that COVID-19 during pregnancy does not increase the rate of CD, contrary to previous reports. A potential explanation is that in our study the PSM reduced confounding factors that could have resulted otherwise in discrepancies of MOD.
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