Universal SARS-Cov-2 Screening in Women Admitted for Delivery in a Large Managed Care Organization

Abstract

Objective The coronavirus disease 2019 (COVID-19) pandemic has created a need for data regarding the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant women. After implementing universal screening for COVID-19 in women admitted for delivery, we sought to describe the characteristics of COVID-19 in this large cohort of women.

Study Design An observational study of women admitted to labor and delivery units in Kaiser Permanente Southern California (KPSC) hospitals between April 6 and May 11, 2020 who were universally offered testing for SARS-CoV-2 infection (n = 3,963). Hospital inpatient and outpatient physician encounter, and laboratory records were used to ascertain universal testing levels, test results, and medical and obstetrical histories. The prevalence of SARS-CoV-2 infection was estimated from the number of women who tested positive during labor per 100 women delivered.

Results Of women delivered during the study period, 3,923 (99.0%) underwent SARS-CoV-2 testing. A total of 17 (0.43%; 95% confidence interval: 0.23–0.63%) women tested positive, and none of them were symptomatic on admission. There was no difference in terms of characteristics between SARS-CoV-2 positive and negative tested women. One woman developed a headache attributed to COVID-19 3 days postpartum. No neonates had a positive test at 24 hours of life.

Conclusion The findings suggest that in pregnant women admitted for delivery between April 6 and May 11, 2020 in this large integrated health care system in Southern California, prevalence of SARS-CoV-2 test positive was very low and all patients were asymptomatic on admission.

Key Points

• The prevalence of SARS-CoV-2 infection in a large diverse cohort of term pregnant women was 0.43%.

• 99% of women accepted SARS-CoV-2 screening on admission to labor and delivery.

• All women with positive test results were asymptomatic at the time of testing.

Keywords

SARS-CoV-2 - pregnancy - COVID-19 - screening

Publikationsverlauf

Eingereicht: 28. Mai 2020

Angenommen: 11. Juni 2020

Artikel online veröffentlicht:
03. Juli 2020

• References

• 1 Society for Maternal-Fetal Medicine and American Congress of Obstetricians and Gynecologists Joint Statement: recent developments regarding COVID-19 and pregnant women. Available at: https://s3.amazonaws.com/cdn.smfm.org/media/2305/joint-statement-recent-developments-regarding-covid-19-and-pregnant-women.pdf . Accessed May 11, 2020
• 2 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; 2 (02) 100118
• 3 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; 382 (22) 2163-2164
• 4 Abbott RealTime SARS-CoV-2 assay [package insert], Des Plaines, IL. Abbott Molecular. Available at: https://www.molecular.abbott/us/en/products/infectious-disease/RealTime-SARS-CoV-2-Assay . Accessed 2020
• 5 Cobas® SARS CoV-2 assay [package insert], Indianapolis, IN. Roche Diagnostics; Available at: https://www.roche.com/media/releases/med-cor-2020-03-13.htm . Accessed 2020
• 6 Vintzileos WS, Muscat J, Hoffmann E. , et al. Screening all pregnant women admitted to labor and delivery for the virus responsible for COVID-19. Am J Obstet Gynecol 2020;
• 7 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
• 8 Liu W, Wang Q, Zhang Q. , et al. Coronavirus disease 2019 (COVID-19) during pregnancy: A case series. Preprints 2020;2020020373. Available at: https://www.preprints.org/manuscript/202002.0373/v1 . Accessed May 5, 2020
• 9 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
• 10 Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 novel coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020; ciaa200
• 11 Zeng L, Xia S, Yuan W. , et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020;
• 12 Dong L, Tian J, He S. , et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020; 323 (18) 1846-1848
• 13 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; 37 (08) 861-865