Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019
Journal
American Journal of Obstetrics & Gynecology MFM
Date Issued
2021-07
Author(s)
D'Antonio, Francesco
Sen, Cihat
Mascio, Daniele Di
Galindo, Alberto
Villalain, Cecilia
Herraiz, Ignacio
Arisoy, Resul
Ovayolu, Ali
Eroğlu, Hasan
Canales, Manuel Guerra
Ladella, Subhashini
Cojocaru, Liviu
Turan, Ozhan
Turan, Sifa
Hadar, Eran
Brzezinski-Sinai, Noa A.
Dollinger, Sarah
Uyaniklar, Ozlem
Ocakouglu, Sakine Rahimli
Atak, Zeliha
Premru-Srsen, Tanja
Kornhauser-Cerar, Lilijana
Druškovič, Mirjam
Ples, Liana
Gündüz, Reyhan
Ağaçayak, Elif
Schvartzman, Javier Alfonso
Malbran, Mercedes Negri
Liberati, Marco
Sebastiano, Francesca Di
Oronzi, Ludovica
Cerra, Chiara
Buca, Danilo
Cagnacci, Angelo
Ramone, Arianna
Barra, Fabio
Carosso, Andrea
Benedetto, Chiara
Cosma, Stefano
Pintiaux, Axelle
Daelemans, Caroline
Costa, Elena
Özel, Ayşegül
Muhçu, Murat
Lopez, Jesús S Jimenez
Alvarado, Clara
Piqueras, Anna Luengo
Oliva, Dolores Esteban
Schera, Giovanni Battista Luca
Volpe, Nicola
Frusca, Tiziana
Hojman, Javier
Turkcuoglu, Ilgin
Cromi, Antonella
Laganà, Antonio Simone
Ghezzi, Fabio
Sirico, Angelo
Familiari, Alessandra
Scambia, Giovanni
Sukhikh, Zulfiya Khodjaeva Gennady T.
Gorina, Ksenia A.
de Sa, Renato Augusto Moreira
Vaz, Mariana
Feuerschuette, Otto Henrique May
Gatta, Anna Nunzia Della
Youssef, Aly
Donna, Gaetana Di
Martinez-Varea, Alicia
Loscalzo, Gabriela
Morales Roselló, José
Stefanovic, Vedran
Nupponen, Irmeli
Nelskylä, Kaisa
Ayala, Rodrigo
Molpeceres, Rebeca Garrote
Vázquez, Asunción Pino
Sandri, Fabrizio
Cataneo, Ilaria
Lenzi, Marinella
Haberal, Esra Tustas
Huertas, Erasmo
Sanchez, Amadeo
Arango, Pedro
Bermejo, Amanda
Alcantara, María Monica Gonzalez
Göynümer, Gökhan
Okuyan, Erhan
Madalina, Ciuhodaru
Guisan, Ana Concheiro
Schulte, Alejandra Martínez
Esposito, Valentina
De Robertis, Valentina
Zdjelar, Snezana
Lackovic, Milan
Mihajlovic, Sladjana
Jekova, Nelly
Saccone, Gabriele
Aslan, Mehmet Musa
Dedda, Maria Carmela Di
Chalid, Maisuri
Canache, Jose Enrique Moros
Daskalakis, George
Antsaklis, Panos
Vega, Enrique Criado
Cueto, Elisa
Taccaliti, Chiara
Aykanat, Yeliz
Özlem Genç, Şerife
Froessler, Bernd
Radulova, Petya Angelova
Morano, Danila
Bianchi, Beatrice
Marino, Maria Giulia Lombana
Meccariello, Gabriella
Rohatgi, Bindu
Schiattarella, Antonio
Morlando, Maddalena
Colacurci, Nicola
Villasco, Andrea
Biglia, Nicoletta
Marques, Ana Luiza Santos
Gatti, Alessandra
Luvero, Daniela
Angioli, Roberto
Pittaro, Alejandro
Lila, Albert
Zlatohlávková, Blanka
DOI
10.1016/j.ajogmf.2021.100329
Abstract
It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations.
OBJECTIVE
This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.
STUDY DESIGN
This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data.
RESULTS
A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03–2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07–2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41–3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42–4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19–5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15–2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02–1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90–5.11; P<.001) were independently associated with adverse maternal outcomes.
CONCLUSION
High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.
OBJECTIVE
This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.
STUDY DESIGN
This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data.
RESULTS
A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03–2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07–2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41–3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42–4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19–5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15–2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02–1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90–5.11; P<.001) were independently associated with adverse maternal outcomes.
CONCLUSION
High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.