A retrospective cohort study published in JAMA found that pregnant and postpartum women with SARS-CoV-2 infection were at a significantly increased risk of maternal mortality or serious morbidity from common obstetric complications.
The authors are clinicians and investigators from the Maternal-Fetal Medicine Units Network, which was created by the National Institute of Child Health and Human Development (NICHD) in 1986.
“We became concerned about the possibility of increased morbidity in patients who acquired the SARS-CoV-2 virus in pregnancy early in the pandemic, due to all the changes in healthcare delivery and delays in presentation to care that we were observing in our practices,” said principal investigator Torri Metz, MD, an associate professor of ob-gyn and vice chair of ob-gyn research at University of Utah Health in Salt Lake City.
The study comprised 14104 pregnant and postpartum patients, mean age 29.7 years, who delivered from March 2020 to December 2020 at 17 U.S. hospitals participating in the NICHD’s Gestational Research Assessments of COVID-19 study.
Overall, 2352 of the included patients tested positive for SARS-CoV-2 infection, based on a positive nucleic acid or antigen test result. The remaining 11752 patients did not have a positive SARS-CoV-2 test and delivered at the same hospitals on randomly selected days.
Among those who were SARS-CoV-2 positive in pregnancy, 80.1% tested positive in the third trimester, 17.6% in the second trimester and 2.3% in the first trimester.
Among the 4.4% of patients who had their first positive test result postpartum, the median timing was 18 days after delivery; only 2.47% tested positive more than 2 weeks after delivery.
The primary outcome was a composite of maternal death or serious morbidity linked to hypertensive disorders of pregnancy, postpartum hemorrhage, or infection other than SARS-CoV-2.
SARS-CoV-2 infection was significantly connected to the primary outcome: 13.4% vs 9.2% for those patients without a positive test result.
All five maternal deaths were in the SARS-CoV-2 group; however, the infection was not significantly associated with the major secondary outcome of cesarean birth: 34.7% vs 32.4%, respectively.
On the other hand, moderate or higher COVID-19 severity was significantly linked to the primary outcome: 26.1% vs 9.2% for patients without a positive test result.
There was also a significant link between infection and cesarean birth among those with moderate or higher COVID-19 severity: 45.4% vs 32.4%, respectively.
But mild or asymptomatic infection was not significantly associated with either the primary outcome or cesarean birth.
“It was surprising to see such a pronounced impact on maternal morbidity and mortality among those with moderate or higher COVID-19 severity,” Metz told Contemporary OB/GYN®. “This could be related to either the effects of the virus itself or to the changes in health care delivery during the time period, or both.”
Metz said study data can be used to counsel pregnant individuals about the risks of SARS-CoV-2 in pregnancy, especially among those with moderate or higher disease severity. “We know that vaccination helps prevent higher severity infections, so these data can also be used to help encourage pregnant people to get vaccinated,” she said.
The authors anticipate that going forward there will be differential effects from different variants of SARS-CoV-2, which will be important to research.
“It will also be valuable to determine if there are long-term ramifications for the mother and offspring with SARS-CoV-2 infection during pregnancy,” said Metz, who noted that MFMU has secured grant funding from the National Heart, Lung, and Blood Institute for such a study.
Metz is a site principal investigator and medical advisory board member for a Pfizer study on SARS-CoV-2 vaccination in pregnancy.
Reference
S4E1: New RNA platform can predict pregnancy complications
February 11th 2022In this episode of Pap Talk, Contemporary OB/GYN® sat down with Maneesh Jain, CEO of Mirvie, and Michal Elovitz, MD, chief medical advisor at Mirvie, a new RNA platform that is able to predict pregnancy complications by revealing the biology of each pregnancy. They discussed recently published data regarding the platform's ability to predict preeclampsia and preterm birth.
Listen
Expert consensus sheds light on diagnosis and management of vasa previa
December 5th 2024A recent review established guidelines for prenatal diagnosis and care of vasa previa, outlining its definition, screening and diagnosis, management, and timing of delivery in asymptomatic patients.
Read More
Contemporary OB/GYN Senior Editor Angie DeRosa gets insight on the current state of COVID-19 from Christina Han, MD, division director of maternal-fetal medicine at the University of California, Los Angeles, and member of its COVID-19 task force. Han is an active member of the Society for Maternal-Fetal Medicine and discusses the issues on behalf of SMFM.
Listen
Cesarean delivery reduces mortality risk in preterm breech births
December 2nd 2024In a recent study, infants born very preterm or extremely preterm had reduced odds of mortality when cesarean delivery was chosen as the mode of delivery, without a notable increase in any morbidity risk.
Read More
Reduced subsequent births reported after severe maternal morbidity
November 26th 2024Women experiencing severe maternal morbidity during their first pregnancy face significantly lower odds of subsequent births, emphasizing the need for personalized reproductive counseling and ongoing monitoring.
Read More