The Relationship between Status at Presentation and Outcomes among Pregnant Women with COVID-19
24. April 2020
27. April 2020
19. Mai 2020 (online)
Objective This study was aimed to compare maternal and pregnancy outcomes of symptomatic and asymptomatic pregnant women with novel coronavirus disease 2019 (COVID-19).
Study Design This is a retrospective cohort study of pregnant women with COVID-19. Pregnant women were divided into two groups based on status at admission, symptomatic or asymptomatic. All testing was done by nasopharyngeal swab using polymerase chain reaction (PCR) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Initially, nasopharyngeal testing was performed only on women with a positive screen (symptoms or exposure) but subsequently, testing was universally performed on all women admitted to labor and delivery. Chi-square and Wilcoxon's rank-sum tests were used to compare outcomes between groups.
Results Eighty-one patients were tested because of a positive screen (symptoms [n = 60] or exposure only [n = 21]) and 75 patients were universally tested (all asymptomatic). In total, there were 46 symptomatic women and 22 asymptomatic women (tested based on exposure only [n = 12] or as part of universal screening [n = 10]) with confirmed COVID-19. Of symptomatic women (n = 46), 27.3% had preterm delivery and 26.1% needed respiratory support while none of the asymptomatic women (n = 22) had preterm delivery or need of respiratory support (p = 0.007 and 0.01, respectively).
Conclusion Pregnant women who presented with COVID19-related symptoms and subsequently tested positive for COVID-19 have a higher rate of preterm delivery and need for respiratory support than asymptomatic pregnant women. It is important to be particularly rigorous in caring for COVID-19 infected pregnant women who present with symptoms.
Respiratory support is often needed for women who present with symptoms.
Low rate of severe disease in women who present without symptoms.
There were no neonatal infections on day 0 of life.
- 1 Chen H, Guo J, Wang C. , et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
- 2 Li N, Han L, Peng M. , et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis 2020 (e-pub ahead of print) Doi: 10.1093/cid/ciaa352
- 3 Zhu H, Wang L, Fang C. , et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9 (01) 51-60
- 4 Breslin N, Baptiste C, Miller R. , et al. COVID-19 in pregnancy: early lessons. Am J Obstet Gynecol MFM 2020 Doi: 10.1016/j.ajogmf.2020.100111
- 5 Breslin N, Baptiste C, Gyamfi-Bannerman C. , et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020 (e-pub ahead of print) Doi: 10.1016/j.ajogmf.2020.100118
- 6 Sutton D, Fuchs K, D'Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med 2020 (e-pub ahead of print) Doi: 10.1056/NEJMc2009316
- 7 Tan L, Wang Q, Zhang D. , et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther 2020; 5 (01) 33
- 8 ACOG Practice Bulletin No. ACOG practice bulletin no. 202: gestational hypertension and preeclampsia. Obstet Gynecol 2019; 133 (01) e1-e25
- 9 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323 (13) 1239-1242 . Doi: 10.1001/jama.2020.2648
- 10 Health NYC. Total count of COVID-19 cases based on patient address by ZIP code. Available at: https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-cases-by-zip-04182020-1.pdf . Accessed April 18, 2020
- 11 Arons MM, Hatfield KM, Reddy SC. , et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. N Engl J Med 2020 (e-pub ahead of print) Doi: 10.1056/NEJMoa2008457
- 12 Chen L, Li Q, Zheng D. , et al. Clinical characteristics of pregnant women with Covid-19 in Wuhan, China. N Engl J Med 2020 (e-pub ahead of print) Doi: 10.1056/NEJMc2009226
- 13 Del Rio C, Malani PN. COVID-19-new insights on a rapidly changing epidemic. JAMA 2020 (e-pub ahead of print) Doi: 10.1001/jama.2020.3072
- 14 Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol 2020 ;S0002–9378(20)30197–6 (e-pub ahead of print) Doi: 10.1016/j.ajog.2020.02.017
- 15 Yan J, Guo J, Fan C. , et al. Coronavirus disease 2019 (COVID-19) in pregnant women: A report based on 116 cases. Am J Obstet Gynecol 2020 ;S0002-9378(20)30462-2 (e-pub ahead of print) Doi: 10.1016/j.ajog.2020.04.014
- 16 Zeng H, Xu C, Fan J. , et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020 (e-pub ahead of print) Doi: 10.1001/jama.2020.4861
- 17 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020 (e-pub ahead of print) Doi: 10.1055/s-0040-1710050