CDC MMWR Sept 2020
#15,754
Historically, pregnant women and their unborn offspring are among the hardest hit during influenza pandemics (see 2009's Pregnancy & Flu: A Bad Combination), and even seasonal flu in known to hit pregnant women harder than non-pregnant women.
Since the emergence of COVID-19 similar concerns have been raised over SARS-CoV-2 infection, and while the evidence has been limited, some early studies/reports include:
Historically, pregnant women and their unborn offspring are among the hardest hit during influenza pandemics (see 2009's Pregnancy & Flu: A Bad Combination), and even seasonal flu in known to hit pregnant women harder than non-pregnant women.
Since the emergence of COVID-19 similar concerns have been raised over SARS-CoV-2 infection, and while the evidence has been limited, some early studies/reports include:
MMWR: Two New Reports On Pregnancy & COVID-19
The CDC maintains a Data on COVID-19 during Pregnancy website, but cautions that:
Because only about a third of case report forms include information on pregnancy status, these numbers likely do not include all pregnant women with COVID-19 in the United States and must be interpreted with caution. The completeness of this variable continues to improve each week.
A November MMWR (Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020) found that `. . . pregnant women were significantly more likely than were nonpregnant women to be admitted to an intensive care unit . .'.
Today we've a new study/analysis published in the American Journal of Obstetrics and Gynecology (AJOG) by researchers at Washington State University that finds that pregnant women are at significantly greater risk from SARS-CoV-2 infection than non-pregnant women.While their absolute risks for severe outcomes was deemed fairly low, pregnant women were more likely to require invasive ventilation and/or ECMO - and were more likely to die - than non-pregnant women.
I've only reproduced the abstract, so follow the link to read the full PDF version.
Disease Severity, Pregnancy Outcomes and Maternal Deaths among Pregnant Patients with SARS-CoV-2 Infection in Washington State
Erica M. Lokken, PhD, MS Emily M. Huebner, MS ∗ G. Gray Taylor, BA ∗ Sylvia M. LaCourse, MD, MPH Kristina M. Adams Waldorf, MD
For the Washington State COVID-19 in Pregnancy Collaborative
Published:January 26, 2021DOI:https://doi.org/10.1016/j.ajog.2020.12.1221
STRUCTURED ABSTRACT
Background
Evidence is accumulating that coronavirus disease 2019 (COVID-19) increases the risk for hospitalization and mechanical ventilation in pregnant patients and for preterm delivery. However, the impact on maternal mortality and whether morbidity is differentially affected by disease severity at delivery and trimester of infection is unknown.
Objectives
To describe disease severity and outcomes of SARS-CoV-2 infections in pregnancy across Washington State including pregnancy complications and outcomes, hospitalization, and case fatality.
Study Design
Pregnant patients with a polymerase chain reaction confirmed SARS-CoV-2 infection between March 1 and June 30, 2020 were identified in a multi-center retrospective cohort study from 35 sites in Washington State. Sites captured 61% of annual state deliveries. Case fatality rates in pregnancy were compared to COVID-19 fatality rates in similarly aged adults in Washington State using rate ratios and rate differences. Maternal and neonatal outcomes were compared by trimester of infection and disease severity at the time of delivery.
Results
The principal study findings were:
1) among 240 pregnant patients in Washington State with SARS-CoV-2 infections, 1 in 11 developed severe or critical disease, 1 in 10 were hospitalized for COVID-19, and 1 in 80 died;
2) the COVID-19-associated hospitalization rate was 3.5-fold higher than in similarly-aged adults in Washington State [10.0% vs. 2.8%; rate ratio (RR) 3.5, 95% confidence interval (CI) 2.3-5.3];
3) pregnant patients hospitalized for a respiratory concern were more likely to have a comorbidity or underlying conditions including asthma, hypertension, type 2 diabetes, autoimmune disease, and Class III obesity;
4) three maternal deaths (1.3%) were attributed to COVID-19 for a maternal mortality rate of 1,250/100,000 pregnancies (95%CI 257-3,653);
5) the COVID-19 case fatality in pregnancy was a significant 13.6-fold (95%CI 2.7-43.6) higher in pregnant patients compared to similarly aged individuals in Washington State with an absolute difference in mortality rate of 1.2% (95%CI -0.3-2.6); and
6) preterm birth was significantly higher among women with severe/critical COVID-19 at delivery than for women who had recovered from COVID-19 (45.4% severe/critical COVID-19 vs. 5.2% mild COVID-19, p<0.001).
Conclusions
COVID-19 hospitalization and case fatality rates in pregnant patients were significantly higher compared to similarly aged adults in Washington State. This data indicates that pregnant patients are at risk for severe or critical disease and mortality compared to non-pregnant adults, as well as preterm birth.
