In a recent study, researchers from France evaluated the association between morbidity and coronavirus disease 2019 (COVID-19). In this retrospective analysis, the researchers found that compared to pregnant women without COVID-19, there was an increased frequency of pregnant women with morbidity and the diagnosis COVID-19.
This PLOS Medicine The study is the first report on obstetric results and morbidity in pregnant women associated with COVID-19.
Study: Obstetric results and morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study. Image credit: mikumistock / Shutterstock.com
In early 2020, the effect of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus responsible for COVID-19, on pregnant women was unknown. While the common symptoms of this disease included mild pneumonia, severe COVID-19 was associated with an increased likelihood of hospitalization, intensive care unit (ICU) or even death.
Previous reports have suggested that SARS-CoV-2 infection increased the risk of morbidity and neonatal disease. These studies have also shown a higher risk of hospitalization and adverse outcomes in SARS-CoV-2-infected pregnant women.
Despite these observations, the risk of morbidity and undesirable obstetric outcomes in pregnant women with COVID-19 must be fully evaluated. Is there a connection between the two?
To answer this question, the researchers behind the current study aimed to determine whether morbidity and unwanted obstetric outcomes were more frequent in pregnant women with COVID-19 compared to pregnant women without COVID-19. The results of this study will help in the treatment policies and management of pregnancies during the COVID-19 pandemic.
The researchers collected data from the French National Hospital Database (PMSI) and took a national cohort of all hospitalized pregnant women for births after 22 weeks of pregnancy in France from January to June 2020. They analyzed 244,645 births during this period, of which 874 women were diagnosed with COVID -19.
The researchers reported that pregnant women with COVID-19 were identified from the database if they were registered with the International Classification of Disease (ICD-10) code for the presence of COVID-19 hospitalization. To confirm hospitalization for COVID-19 in women, the researchers included having COVID-19 symptoms associated with signs of COVID-19 on computed tomography (CT) breast scans, a positive reverse transcriptase polymerase chain reaction (RT-PCR) and / or antigen testing and / or serology test positive for COVID-19. Both symptomatic and asymptomatic patients were included in this study.
The researchers presented all the characteristics of women with and without a COVID-19 diagnosis, including the obstetric complications according to the presence or absence of the COVID-19 diagnosis. The model used in this study adjusted for patient characteristics, including maternal age, body mass index, active smoking, parity, history of diabetes or hypertension, multiple pregnancies, and assisted reproduction (ART) fertilization.
Compared to pregnant women without COVID-19, those with COVID-19 were older, more likely to be overweight, had multiple pregnancies, and had a history of hypertension. The researchers observed that the frequency of fertilization with assisted reproduction technique (ART) did not differ between those with and without a COVID-19 diagnosis.
Compared to the non-COVID group, pregnant women with COVID-19 had an increased likelihood of being admitted to the intensive care unit (ICU), mortality, preeclampsia / eclampsia, gestational hypertension, postpartum haemorrhage, premature birth after less than 37 weeks, 32 weeks and 28 weeks of gestation, induced premature birth, spontaneous preterm birth, fetal distress, and cesarean section.
Consistent with previous studies, the frequency and severity of preterm births, both spontaneous and medically induced, were more likely to occur in pregnant women with COVID-19. In particular, fetal distress was also more prevalent in COVID-19 cases.
Other complications such as abortions after 22 weeks of gestation, stillbirths, gestational diabetes, placenta praevia, placental abruption and venous thromboembolic events were similar between the COVID-19 and non-COVID-19 groups.
By comparing two groups of pregnant women with or without COVID-19 during the first wave of the COVID-19 pandemic, the current study aimed at whether COVID-19 is associated with an increased risk of unwanted obstetric outcomes among pregnant women.
This study presented a retrospective observation of an increased frequency of pregnant women with morbidity and diagnosis of COVID-19 compared to pregnant women without COVID-19. These results indicate that pregnant women with COVID-19 pose an increased risk of obstetric diseases.
Especially in populations with a known risk of developing a serious infection or obstetric disorders, it is important to be informed about the options involved. This can ensure that obstetric wards better inform pregnant women and provide the best care under such scenarios.
Based on the results of this study, the researchers confirmed the latest recommendations on vaccination for pregnant women.