Strategies are needed to minimize the risks of preeclampsia, preterm birth, thrombotic events, and in-hospital mortality of women giving birth with COVID-19, according to the findings of a large national cohort study published in JAMA Internal Medicine.
So far, the effects of COVID-19 in pregnancy have not been clearly defined. Study investigators compared the clinical characteristics and outcomes of hospitalized women with and without COVID-19 who gave birth between April 1 and November 23, 2020. Of the 406,446 hospitalized, pregnant women, 6380 (1.6%) were infected with COVID-19.
Among the 6380 women with COVID-19, 6309 (98.9%) were discharged, 212 (3.3%) needed intensive care, 86 (1.3%) required mechanical ventilation, and 9 (0.1%) died. Of the patients who required additional care, these women were often younger, often Black and/or Hispanic, and had comorbidities such as diabetes and obesity.
Results from the study indicated pregnant women with COVID-19 were associated with an increased risk of preeclampsia (adjusted odds ratio [aOR], 1.21; 95% CI, 1.11-1.33) and preterm birth (aOR, 1.17; 95% CI, 1.06-1.29). Additionally, myocardial infarction and venous thromboembolism rates were higher in women with COVID-19 (P <.001). Although there was a low number of deaths among the women giving birth, in-hospital mortality was higher in women with COVID-19 compared with those without (141 [95% CI, 65-268] vs 5.0 [95% CI, 3.1-7.7] deaths per 100,000 women).
Limitations of this study include the following:
- Misclassification of women by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes
- Lack of information detailing disease severity
- Inability to differentiate between asymptomatic and symptomatic COVID-19 patients
- Low clinical outcome rates
“As studies investigating therapies for COVID-19 have largely excluded pregnant women, the data also underscore the importance of including this population in clinical trials of treatments and vaccines,” the study authors concluded.
Jering KS, Claggett BL, Cunningham JW, et al. Clinical characteristics and outcomes of hospitalized women giving birth with and without COVID-19. JAMA Intern Med. Published online January 15, 2021. doi:10.1001/jamainternmed.2020.9241.