Pregnant and postpartum women requiring intensive care treatment for COVID-19-first data from the CRONOS-registry

ABSTRACT

Background Critical illness during pregnancy puts mother and fetus at serious risks. Current literature regarding the effect of coronavirus 2 (SARS-CoV-2) describes an increased risk for maternal mortality as well as high rates of preterm delivery, however data vary and depend on the respective health care system. We aimed to describe maternal characteristics and clinical presentation of SARS-CoV-2 positive pregnant and postpartum women requiring intensive care treatment for COVID-19 in Germany, in order to explore risk factors for severe COVID-19 courses as well as to provide an overview on treatments applied. Methods COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS), an ongoing prospective multicenter registry for SARS-CoV-2 positive pregnant women from 150 centres in Germany was analyzed with respect to intensive care treatment for COVID-19. We extracted information for all women requiring intensive care treatment for COVID-19 and compared maternal characteristics, course of disease, as well as maternal and neonatal outcomes. Results Out of 2445 cases in CRONOS registry, 96 women (4%) had a documented intensive care unit (ICU) stay and were analyzed. While 75 (78%) women were pregnant when receiving ICU treatment, 21 (22%) were admitted post-delivery. Median maternal age was 33 (IQR, 30-36) years. COVID-19 was diagnosed at a median gestational age of 32 (IQR, 28-35) weeks. We observed the following interventions as highest form of treatment required for COVID-19 continuous monitoring of vital signs (n=6 (6%)), insufflation of oxygen (n=32 (33%)), non-invasive ventilation (n=17 (18%)), invasive ventilation (n=29 (30%)) and escalation to extracorporeal membrane oxygenation (ECMO, n=12 (13%)). Maternal characteristics such as maternal age, ethnicity, body mass index at admission, history of smoking, comorbidities and concomitant medication, as well as gestational age were analyzed. No significant differences between patients receiving different forms of respiratory therapy for COVID-19 could be identified. Preterm delivery was observed in 45 women (47%). Two women (2%) died of COVID-19 and four fetuses (4%) were stillborn. Conclusions Our cohort shows that progression of COVID-19 in pregnant and postpartum women requiring ICU treatment is rare. Preterm birth rate is high and COVID-19 requiring respiratory support is not necessarily related to poor maternal or neonatal outcome. But, as one in ten patients admitted to ICU might require ECMO therapy, all pregnant women suffering from COVID-19 should be closely monitored. In future studies, detail about obstetric women requiring intensive care treatment for COVID-19 should be further evaluated.