ABSTRACT
SARS-CoV-2 infection and COVID-19 disease are associated with an increased risk of hypertensive pregnancy disease in international registry studies. Preexisting hypertensive disorders are recognized as a risk factor of severe COVID-19 progression in pregnancy. The respective damage to the endothelium is discussed as a pathophysiological commonality of both diseases.Data of the national CRONOS registry (data status 05/2021; 1104 pregnant women with SARS-CoV-2 infection) were analyzed regarding the association of hypertensive pregnancy disease and maternal, pregnancy, neonatal, and COVID-19 disease outcomes. In the presence of hypertensive pregnancy disease, a severe combined outcome of pregnancy (17.3 vs. 4.3%, p=0.001), mother (25.0 vs. 9.4%, p=0.001), and newborn (28.8 vs. 9.1%, p<0.0005) occurred significantly more frequent. In contrast, the outcome of COVID-19 disease did not differ (3.8 vs. 7.5%, p=0.424). The co-occurrence of SARS-CoV-2 infection and hypertensive pregnancy disease should be acknowledged as risk factor during management decisions.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is an infectious disease that can lead to severe respiratory symptoms. Pregnant women have an increased risk for a severe course. Therefore, the Association of the Scientific Medical Societies in Germany (AWMF) Guidelines 015/092 "SARS-CoV-2 in pregnancy, childbirth, and the puerperium" were established to standardize care in the COVID-19 pandemic. The guideline group used data from the "COVID-19 related obstetrics and neonatal outcome study" (CRONOS) to generate evidence-based recommendations for action. CRONOS collects data from more than 130 affiliated maternity hospitals nationwide in Germany. According to the study, pregnant women positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are often asymptomatic;however, in 1 out of 25 detected infections there is a severe course requiring intensive medical treatment. Thromboembolism occurs in 1 out of 30 women hospitalized for COVID-19. An infection of the neonate of a mother infected peripartum is occasionally detected (about 1 out of 20 infants) and usually remains without consequence in the short-term outcome. Many other questions have been answered using CRONOS data. The registry is still open and recruiting and will also provide more in-depth information on different virus variants and vaccination in the future with more than 6000 cases. CRONOS is exemplary for an unprecedented cooperation of gynecologists during the pandemic.
ABSTRACT
COVID(„coronavirus disease“)-19 ist eine Infektionserkrankung, die zu schweren respiratorischen Symptomen führen kann. Schwangere haben ein erhöhtes Risiko für einen schweren Verlauf. Für eine gute Betreuung in der COVID-19-Pandemie wurde daher die AWMF(Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften)-Leitlinie 015/092 „SARS-CoV‑2 in Schwangerschaft, Geburt und Wochenbett“ erstellt. Die Leitliniengruppe nutzte zur Erstellung von evidenzbasierten Handlungsempfehlungen die Daten der „Covid-19 Related Obstetrics and Neonatal Outcome Study“ (CRONOS). CRONOS sammelt deutschlandweit Daten aus mehr als 130 angeschlossenen Geburtenkliniken. SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-positive Schwangere sind demnach häufig asymptomatisch. Bei 1 von 25 erkannten Infektionen kommt es jedoch zu einem schweren Verlauf mit intensivmedizinischer Behandlung. Bei 1 von 30 stationär wegen COVID-19 behandelten Frauen kommt es zu einer Thromboembolie. Eine Infektion des Neugeborenen einer peripartal infizierten Mutter wird gelegentlich (etwa 1 von 20 Kindern) nachgewiesen und bleibt in der Regel ohne Konsequenz im Kurzzeit-Outcome. Viele weitere Fragestellungen wurden mithilfe von CRONOS beantwortet. Das weiter aktiv rekrutierende Register wird zukünftig mit mehr als 6000 Fällen auch tiefere Informationen zu verschiedenen Virusvarianten und zum Impfen liefern. CRONOS steht vorbildlich für eine beispiellose Kooperation von Ärztinnen und Ärzten der Frauenheilkunde in der Pandemie.
ABSTRACT
BACKGROUND: Gestational diabetes mellitus is one of the most frequent pregnancy complications with a global prevalence of 13.4% in 2021. Pregnant women with COVID-19 and gestational diabetes mellitus are 3.3 times more likely to be admitted to an intensive care unit than women without gestational diabetes mellitus. Data on the association of gestational diabetes mellitus with maternal and neonatal pregnancy outcomes in pregnant women with SARS-CoV-2 infection are lacking. OBJECTIVE: This study aimed to investigate whether gestational diabetes mellitus is an independent risk factor for adverse maternal and fetal and neonatal outcomes in pregnant women with COVID-19. STUDY DESIGN: The COVID-19-Related Obstetric and Neonatal Outcome Study is a registry-based multicentric prospective observational study from Germany and Linz, Austria. Pregnant women with clinically confirmed COVID-19 were enrolled between April 3, 2020, and August 24, 2021, at any stage of pregnancy. Obstetricians and neonatologists of 115 hospitals actively provided data to the COVID-19-Related Obstetric and Neonatal Outcome Study. For collecting data, a cloud-based electronic data platform was developed. Women and neonates were observed until hospital discharge. Information on demographic characteristics, comorbidities, medical history, COVID-19-associated symptoms and treatments, pregnancy, and birth outcomes were entered by the local sites. Information on the periconceptional body mass index was collected. A primary combined maternal endpoint was defined as (1) admission to an intensive care unit (including maternal mortality), (2) viral pneumonia, and/or (3) oxygen supplementation. A primary combined fetal and neonatal endpoint was defined as (1) stillbirth at ≥24 0/7 weeks of gestation, (2) neonatal death ≤7 days after delivery, and/or (3) transfer to a neonatal intensive care unit. Multivariable logistic regression analysis was performed to evaluate the modulating effect of gestational diabetes mellitus on the defined endpoints. RESULTS: Of the 1490 women with COVID-19 (mean age, 31.0±5.2 years; 40.7% nulliparous), 140 (9.4%) were diagnosed with gestational diabetes mellitus; of these, 42.9% were treated with insulin. Overall, gestational diabetes mellitus was not associated with an adverse maternal outcome (odds ratio, 1.50; 95% confidence interval, 0.88-2.57). However, in women who were overweight or obese, gestational diabetes mellitus was independently associated with the primary maternal outcome (adjusted odds ratio, 2.69; 95% confidence interval, 1.43-5.07). Women who were overweight or obese with gestational diabetes mellitus requiring insulin treatment were found to have an increased risk of a severe course of COVID-19 (adjusted odds ratio, 3.05; 95% confidence interval, 1.38-6.73). Adverse maternal outcomes were more common when COVID-19 was diagnosed with or shortly after gestational diabetes mellitus diagnosis than COVID-19 diagnosis before gestational diabetes mellitus diagnosis (19.6% vs 5.6%; P<.05). Maternal gestational diabetes mellitus and maternal preconception body mass index of ≥25 kg/m2 increased the risk of adverse fetal and neonatal outcomes (adjusted odds ratio, 1.83; 95% confidence interval, 1.05-3.18). Furthermore, overweight and obesity (irrespective of gestational diabetes mellitus status) were influential factors for the maternal (adjusted odds ratio, 1.87; 95% confidence interval, 1.26-2.75) and neonatal (adjusted odds ratio, 1.81; 95% confidence interval, 1.32-2.48) primary endpoints compared with underweight or normal weight. CONCLUSION: Gestational diabetes mellitus, combined with periconceptional overweight or obesity, was independently associated with a severe maternal course of COVID-19, especially when the mother required insulin and COVID-19 was diagnosed with or after gestational diabetes mellitus diagnosis. These combined factors exhibited a moderate effect on neonatal outcomes. Women with gestational diabetes mellitus and a body mass index of ≥25 kg/m2 were a particularly vulnerable group in the case of COVID-19.