Am J Perinatol
DOI: 10.1055/s-0041-1723761
Original Article

Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience

Marissa Berry
1  Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
,
Amanda Wang
1  Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
,
Shannon M. Clark
1  Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
,
Hassan M. Harirah
1  Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
,
Sangeeta Jain
1  Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
,
Gayle L. Olson
1  Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
,
Luis D. Pacheco
1  Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
,
George R. Saade
1  Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
,
1  Division of Maternal-Fetal Medicine, The University of Texas Medical Branch, Galveston, Texas
› Author Affiliations
Funding None.

Abstract

Objective The aim of this study was to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes.

Study Design This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant.

Results Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19.

Conclusion Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy.

Key Points

  • The majority of pregnant patients with COVID-19 are asymptomatic and <1 in 20 require oxygen support.

  • Women in the later stages of pregnancy may be at increased risk for severe infection.

  • Anemia, leukopenia, CRP, ferritin, and procalcitonin are associated with increasing severity.



Publication History

Received: 08 December 2020

Accepted: 05 January 2021

Publication Date:
06 February 2021 (online)

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