Disease Severity and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019 (COVID-19)

Torri D. Metz; Rebecca G. Clifton; Brenna L. Hughes; Grecio Sandoval; George R. Saade; William A. Grobman; Tracy A. Manuck; Menachem Miodovnik; Amber Sowles; Kelly Clark; Cynthia Gyamfi-Bannerman; Hector Mendez-Figueroa; Harish M. Sehdev; Dwight J. Rouse; Alan T.N. Tita; Jennifer Bailit; Maged M. Costantine; Hyagriv N. Simhan; George A. Macones

doi:10.1097/AOG.0000000000004339

Disease Severity and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019 (COVID-19)

Torri D. Metz^*, Rebecca G. Clifton, Brenna L. Hughes, Grecio Sandoval, George R. Saade, William A. Grobman, Tracy A. Manuck, Menachem Miodovnik, Amber Sowles, Kelly Clark, Cynthia Gyamfi-Bannerman, Hector Mendez-Figueroa, Harish M. Sehdev, Dwight J. Rouse, Alan T.N. Tita, Jennifer Bailit, Maged M. Costantine, Hyagriv N. Simhan, George A. Macones

^*Corresponding author for this work

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

312 Scopus citations

Abstract

OBJECTIVE:To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes.METHODS:We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at 1 of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. Disease severity was classified by National Institutes of Health criteria. Maternal, fetal, and neonatal outcomes were abstracted by centrally trained and certified perinatal research staff. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling.RESULTS:A total of 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe, 4% critical. Overall, 53% were Hispanic; there was no trend in race-ethnicity distribution by disease severity. Those with more severe illness had older mean age, higher median body mass index, and pre-existing medical comorbidities. Four maternal deaths (0.3%) were attributed to COVID-19. Frequency of perinatal death or a positive neonatal SARS-CoV-2 test result did not differ by severity. Adverse perinatal outcomes were more frequent among patients with more severe illness, including 6% (95% CI 2-11%) incidence of venous thromboembolism among those with severe-critical illness compared with 0.2% in mild-moderate and 0% in asymptomatic (P<.001 for trend across severity). In adjusted analyses, severe-critical COVID-19 was associated with increased risk of cesarean birth (59.6% vs 34.0%, adjusted relative risk [aRR] 1.57, 95% CI 1.30-1.90), hypertensive disorders of pregnancy (40.4% vs 18.8%, aRR 1.61, 95% CI 1.18-2.20), and preterm birth (41.8% vs 11.9%, aRR 3.53, 95% CI 2.42-5.14) compared with asymptomatic patients. Mild-moderate COVID-19 was not associated with adverse perinatal outcomes compared with asymptomatic patients.CONCLUSION:Compared with pregnant patients with SARS-CoV-2 infection without symptoms, those with severe-critical COVID-19, but not those with mild-moderate COVID-19, were at increased risk of perinatal complications.

Original language	English (US)
Pages (from-to)	571-580
Number of pages	10
Journal	Obstetrics and gynecology
Volume	137
Issue number	4
DOIs	https://doi.org/10.1097/AOG.0000000000004339
State	Published - Apr 1 2021

Funding

This work is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (UG1 HD087230, UG1 HD027869, UG1 HD027915, UG1 HD034208, UG1 HD040500, UG1 HD040485, UG1 HD053097, UG1 HD040544, UG1 HD040545, UG1 HD040560, UG1 HD040512, UG1 HD087192, U10 HD036801) and the National Center for Advancing Translational Sciences (UL1TR001873). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

ASJC Scopus subject areas

Obstetrics and Gynecology

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10.1097/AOG.0000000000004339

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Metz, T. D., Clifton, R. G., Hughes, B. L., Sandoval, G., Saade, G. R., Grobman, W. A., Manuck, T. A., Miodovnik, M., Sowles, A., Clark, K., Gyamfi-Bannerman, C., Mendez-Figueroa, H., Sehdev, H. M., Rouse, D. J., Tita, A. T. N., Bailit, J., Costantine, M. M., Simhan, H. N., & Macones, G. A. (2021). Disease Severity and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019 (COVID-19). Obstetrics and gynecology, 137(4), 571-580. https://doi.org/10.1097/AOG.0000000000004339

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title = "Disease Severity and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019 (COVID-19)",

abstract = "OBJECTIVE:To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes.METHODS:We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at 1 of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. Disease severity was classified by National Institutes of Health criteria. Maternal, fetal, and neonatal outcomes were abstracted by centrally trained and certified perinatal research staff. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling.RESULTS:A total of 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe, 4% critical. Overall, 53% were Hispanic; there was no trend in race-ethnicity distribution by disease severity. Those with more severe illness had older mean age, higher median body mass index, and pre-existing medical comorbidities. Four maternal deaths (0.3%) were attributed to COVID-19. Frequency of perinatal death or a positive neonatal SARS-CoV-2 test result did not differ by severity. Adverse perinatal outcomes were more frequent among patients with more severe illness, including 6% (95% CI 2-11%) incidence of venous thromboembolism among those with severe-critical illness compared with 0.2% in mild-moderate and 0% in asymptomatic (P<.001 for trend across severity). In adjusted analyses, severe-critical COVID-19 was associated with increased risk of cesarean birth (59.6% vs 34.0%, adjusted relative risk [aRR] 1.57, 95% CI 1.30-1.90), hypertensive disorders of pregnancy (40.4% vs 18.8%, aRR 1.61, 95% CI 1.18-2.20), and preterm birth (41.8% vs 11.9%, aRR 3.53, 95% CI 2.42-5.14) compared with asymptomatic patients. Mild-moderate COVID-19 was not associated with adverse perinatal outcomes compared with asymptomatic patients.CONCLUSION:Compared with pregnant patients with SARS-CoV-2 infection without symptoms, those with severe-critical COVID-19, but not those with mild-moderate COVID-19, were at increased risk of perinatal complications.",

author = "Metz, {Torri D.} and Clifton, {Rebecca G.} and Hughes, {Brenna L.} and Grecio Sandoval and Saade, {George R.} and Grobman, {William A.} and Manuck, {Tracy A.} and Menachem Miodovnik and Amber Sowles and Kelly Clark and Cynthia Gyamfi-Bannerman and Hector Mendez-Figueroa and Sehdev, {Harish M.} and Rouse, {Dwight J.} and Tita, {Alan T.N.} and Jennifer Bailit and Costantine, {Maged M.} and Simhan, {Hyagriv N.} and Macones, {George A.}",

year = "2021",

month = apr,

day = "1",

doi = "10.1097/AOG.0000000000004339",

language = "English (US)",

volume = "137",

pages = "571--580",

journal = "Obstetrics and gynecology",

issn = "0029-7844",

publisher = "Lippincott Williams and Wilkins",

number = "4",

}

Metz, TD, Clifton, RG, Hughes, BL, Sandoval, G, Saade, GR, Grobman, WA, Manuck, TA, Miodovnik, M, Sowles, A, Clark, K, Gyamfi-Bannerman, C, Mendez-Figueroa, H, Sehdev, HM, Rouse, DJ, Tita, ATN, Bailit, J, Costantine, MM, Simhan, HN & Macones, GA 2021, 'Disease Severity and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019 (COVID-19)', Obstetrics and gynecology, vol. 137, no. 4, pp. 571-580. https://doi.org/10.1097/AOG.0000000000004339

TY - JOUR

T1 - Disease Severity and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019 (COVID-19)

AU - Metz, Torri D.

AU - Clifton, Rebecca G.

AU - Hughes, Brenna L.

AU - Sandoval, Grecio

AU - Saade, George R.

AU - Grobman, William A.

AU - Manuck, Tracy A.

AU - Miodovnik, Menachem

AU - Sowles, Amber

AU - Clark, Kelly

AU - Gyamfi-Bannerman, Cynthia

AU - Mendez-Figueroa, Hector

AU - Sehdev, Harish M.

AU - Rouse, Dwight J.

AU - Tita, Alan T.N.

AU - Bailit, Jennifer

AU - Costantine, Maged M.

AU - Simhan, Hyagriv N.

AU - Macones, George A.

PY - 2021/4/1

Y1 - 2021/4/1

N2 - OBJECTIVE:To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes.METHODS:We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at 1 of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. Disease severity was classified by National Institutes of Health criteria. Maternal, fetal, and neonatal outcomes were abstracted by centrally trained and certified perinatal research staff. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling.RESULTS:A total of 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe, 4% critical. Overall, 53% were Hispanic; there was no trend in race-ethnicity distribution by disease severity. Those with more severe illness had older mean age, higher median body mass index, and pre-existing medical comorbidities. Four maternal deaths (0.3%) were attributed to COVID-19. Frequency of perinatal death or a positive neonatal SARS-CoV-2 test result did not differ by severity. Adverse perinatal outcomes were more frequent among patients with more severe illness, including 6% (95% CI 2-11%) incidence of venous thromboembolism among those with severe-critical illness compared with 0.2% in mild-moderate and 0% in asymptomatic (P<.001 for trend across severity). In adjusted analyses, severe-critical COVID-19 was associated with increased risk of cesarean birth (59.6% vs 34.0%, adjusted relative risk [aRR] 1.57, 95% CI 1.30-1.90), hypertensive disorders of pregnancy (40.4% vs 18.8%, aRR 1.61, 95% CI 1.18-2.20), and preterm birth (41.8% vs 11.9%, aRR 3.53, 95% CI 2.42-5.14) compared with asymptomatic patients. Mild-moderate COVID-19 was not associated with adverse perinatal outcomes compared with asymptomatic patients.CONCLUSION:Compared with pregnant patients with SARS-CoV-2 infection without symptoms, those with severe-critical COVID-19, but not those with mild-moderate COVID-19, were at increased risk of perinatal complications.

AB - OBJECTIVE:To describe coronavirus disease 2019 (COVID-19) severity in pregnant patients and evaluate the association between disease severity and perinatal outcomes.METHODS:We conducted an observational cohort study of all pregnant patients with a singleton gestation and a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who delivered at 1 of 33 U.S. hospitals in 14 states from March 1 to July 31, 2020. Disease severity was classified by National Institutes of Health criteria. Maternal, fetal, and neonatal outcomes were abstracted by centrally trained and certified perinatal research staff. We evaluated trends in maternal characteristics and outcomes across COVID-19 severity classes and associations between severity and outcomes by multivariable modeling.RESULTS:A total of 1,219 patients were included: 47% asymptomatic, 27% mild, 14% moderate, 8% severe, 4% critical. Overall, 53% were Hispanic; there was no trend in race-ethnicity distribution by disease severity. Those with more severe illness had older mean age, higher median body mass index, and pre-existing medical comorbidities. Four maternal deaths (0.3%) were attributed to COVID-19. Frequency of perinatal death or a positive neonatal SARS-CoV-2 test result did not differ by severity. Adverse perinatal outcomes were more frequent among patients with more severe illness, including 6% (95% CI 2-11%) incidence of venous thromboembolism among those with severe-critical illness compared with 0.2% in mild-moderate and 0% in asymptomatic (P<.001 for trend across severity). In adjusted analyses, severe-critical COVID-19 was associated with increased risk of cesarean birth (59.6% vs 34.0%, adjusted relative risk [aRR] 1.57, 95% CI 1.30-1.90), hypertensive disorders of pregnancy (40.4% vs 18.8%, aRR 1.61, 95% CI 1.18-2.20), and preterm birth (41.8% vs 11.9%, aRR 3.53, 95% CI 2.42-5.14) compared with asymptomatic patients. Mild-moderate COVID-19 was not associated with adverse perinatal outcomes compared with asymptomatic patients.CONCLUSION:Compared with pregnant patients with SARS-CoV-2 infection without symptoms, those with severe-critical COVID-19, but not those with mild-moderate COVID-19, were at increased risk of perinatal complications.

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Disease Severity and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019 (COVID-19)

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