JAMA Network Open published a recent national-level analysis from the USA, which identified COVID-19 infection as a severe risk factor for adverse maternal outcomes, including morbidity and mortality, among pregnant women at delivery during the early part of the COVID-19 pandemic. Nevertheless, mortality rates decreased from 232.9 to 79.1 per 100,000 deliveries over the course of the study.
The study authors note that there is a growing recognition of the impact of COVID-19 infection on pregnant patients and pregnancy outcomes, as demonstrated by previous research. Although limited national-level data is available comparing the risks associated with COVID-19 infection and pregnancy outcomes, it does appear that COVID-19 increases the likelihood of negative pregnancy outcomes.
The evaluation of the initial pandemic period in this study demonstrates the substantial morbidity and mortality of COVID-19 in pregnant patients,
the study authors say.
The study aimed to assess the impact of COVID-19 infection on maternal outcomes during the early stages of the pandemic in the US. The study analyzed data from 2,578,095 hospital deliveries between April and December 2020, across more than 2691 centers. The patient estimates included 5.7% Asian, 14.7% Black, 20.6% Hispanic, and 50.7% White individuals.
The study focused on two primary endpoints: patient characteristics associated with COVID-19 infection, and severe maternal morbidity and mortality linked to COVID-19 at delivery, adjusting for known obstetric and delivery factors.
Out of 45,425 women who gave birth during the study period, 45,425 were diagnosed with COVID-19. The following characteristics were linked to maternal COVID-19 infection: younger age, later study period, Black and Hispanic patients, lower household income, obesity, medical comorbidity, homelessness status, residing in the US Northeast, earlier gestational age, and admission to a larger urban hospital.
Pregnant women with COVID-19 infection at delivery were at greater risk of severe maternal morbidity, including tracheostomy, ventilation, acute myocardial infarction, sepsis, shock, cardiac arrest, coagulopathy, and respiratory distress syndrome.
Furthermore, women who were diagnosed with COVID-19 during delivery were at a significantly higher risk of mortality, with a 14 times greater likelihood compared to those without COVID-19. Among women who died during hospital admission in the later period, the average time-to-death was 16 days, while it was 6 days from April to June 2020. However, the overall fatality rate decreased between April and December 2020.
The study’s limitations included a lack of information on the severity and treatment of COVID-19 infection status. Additionally, it did not provide details on neonatal outcomes, delivery indication, or cause of death, highlighting the need for further research and evaluation.