Having children at home and risk of COVID-19 in pregnancy

Researchers from Northwestern University Feinberg School of Medicine say that women who have children at home may be at higher risk of severe coronavirus 2 infection (commonly known as COVID-19) in pregnancy. The finding, from a retrospective cohort study, persisted even after controlling for confounders.

Published in the American Journal of Obstetrics and Gynecology MFM,¹ the data reflect outcomes in women who delivered or intended to deliver at Northwestern Memorial Hospital between April 8, 2020 and May 31, 2020. The women were dichotomized by whether they had COVID-19 infection.

Of 1,418 women who met inclusion criteria, 7.1% (101) tested positive for COVID-19 and 76.2% (77) of whom had symptoms at diagnosis. Because some of the patients were recruited during a time interval where only women with symptoms were tested, this rate of severe symptoms cannot be extrapolated to the general pregnant population.

Compared with women who had a negative test result for COVID-19, those who were positive were more likely to:

• Be younger
• Have public insurance
• Identify as Black, African-American or Latin
• Be unmarried
• Be obese
• Have pre-existing pulmonary disease
• Have living children

Compared with women with no living children, those with living children had higher odds of testing positive for COVID-19, and the risk increased with the number of children: 1 child, odds ratio (OR) 2.5; 95% confidence interval (CI) 1.5 to 4.0; 2 living children, OR 2.1; 95% CI 1.0 to 4.1; 3 living children, OR 4.1; 95% CI 1.6 to 10.5; ≥ 4 living children, OR 7.0; 95% CI 2.8 to 17.7.

Having living children still was significantly associated with an increased risk of COVID-19 infection even after adjustment in multivariable analyses for maternal age, insurance, obesity, and pulmonary disease.

The association was not substantively changed when the model included all other variables significantly associated with COVID-19 infection (adjusted OR, 2.298; 95% CI 1.11 to 4.74). There was no significant effect modification between race or ethnicity and number of living children with respect to COVID-19 infection.

The authors speculate that the “number of living children may reflect a higher household density, independent of children themselves being a vector. This may inhibit ability of pregnant women to follow social distancing and isolate children infected with SARS-CoV-2. Finally, residential segregation by race or ethnicity may also contribute to disparities in SARS-CoV-2 prevalence.”

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Reference

1. Sakowicz A, Ayala AE, Ukeje CC, et al. Risk factors for severe acute respiratory syndrome coronavirus 2 infection in pregnant women. Am J Obstet Gynecol MFM. 2020 Nov;2(4):100198.