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Clinical characteristics of 46 pregnant women with a severe acute respiratory syndrome coronavirus 2 infection in Washington State.
Lokken, Erica M; Walker, Christie L; Delaney, Shani; Kachikis, Alisa; Kretzer, Nicole M; Erickson, Anne; Resnick, Rebecca; Vanderhoeven, Jeroen; Hwang, Joseph K; Barnhart, Nena; Rah, Jasmine; McCartney, Stephen A; Ma, Kimberly K; Huebner, Emily M; Thomas, Chad; Sheng, Jessica S; Paek, Bettina W; Retzlaff, Kristin; Kline, Carolyn R; Munson, Jeff; Blain, Michela; LaCourse, Sylvia M; Deutsch, Gail; Adams Waldorf, Kristina M.
  • Lokken EM; Department of Global Health, University of Washington, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
  • Walker CL; MultiCare Health System, Tacoma, WA.
  • Delaney S; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
  • Kachikis A; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
  • Kretzer NM; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
  • Erickson A; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
  • Resnick R; Medical Scientist Training Program, School of Medicine, University of Washington, Seattle, WA.
  • Vanderhoeven J; Swedish Maternal and Fetal Specialty Center, Swedish Medical Center, and Obstetrix Medical Group, Seattle, WA.
  • Hwang JK; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
  • Barnhart N; Department of Obstetrics and Gynecology, PeaceHealth St. Joseph's Medical Center, Bellingham, WA.
  • Rah J; School of Medicine, University of Washington, Seattle, WA.
  • McCartney SA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
  • Ma KK; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
  • Huebner EM; School of Medicine, University of Washington, Seattle, WA.
  • Thomas C; Department of Obstetrics and Gynecology, PeaceHealth St. Joseph's Medical Center, Bellingham, WA.
  • Sheng JS; MultiCare Health System, Tacoma, WA.
  • Paek BW; Eastside Maternal-Fetal Medicine, EvergreenHealth Medical Center, Kirkland, WA; Obstetrix of Washington, Bellevue, WA.
  • Retzlaff K; Quality Department, EvergreenHealth Medical Center, Kirkland, WA.
  • Kline CR; Eastside Maternal-Fetal Medicine, EvergreenHealth Medical Center, Kirkland, WA; Obstetrix of Washington, Bellevue, WA.
  • Munson J; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
  • Blain M; Department of Medicine, University of Washington, Seattle, WA.
  • LaCourse SM; Department of Global Health, University of Washington, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA.
  • Deutsch G; Department of Pathology, University of Washington, Seattle, WA; Department of Pathology, Seattle Children's Hospital, Seattle, WA.
  • Adams Waldorf KM; Department of Global Health, University of Washington, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA. Electronic address: adamsk@uw.edu.
Am J Obstet Gynecol ; 223(6): 911.e1-911.e14, 2020 12.
Article in English | MEDLINE | ID: covidwho-655482
ABSTRACT

BACKGROUND:

The impact of coronavirus disease 2019 on pregnant women is incompletely understood, but early data from case series suggest a variable course of illness from asymptomatic or mild disease to maternal death. It is unclear whether pregnant women manifest enhanced disease similar to influenza viral infection or whether specific risk factors might predispose to severe disease.

OBJECTIVE:

To describe maternal disease and obstetrical outcomes associated with coronavirus disease 2019 in pregnancy to rapidly inform clinical care. STUDY

DESIGN:

This is a retrospective study of pregnant patients with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 6 hospital systems in Washington State between Jan. 21, 2020, and April 17, 2020. Demographics, medical and obstetrical history, and coronavirus disease 2019 encounter data were abstracted from medical records.

RESULTS:

A total of 46 pregnant patients with a severe acute respiratory syndrome coronavirus 2 infection were identified from hospital systems capturing 40% of births in Washington State. Nearly all pregnant individuals with a severe acute respiratory syndrome coronavirus 2 infection were symptomatic (93.5%, n=43) and the majority were in their second or third trimester (43.5% [n=20] and 50.0% [n=23], respectively). Symptoms resolved in a median of 24 days (interquartile range, 13-37). Notably, 7 women were hospitalized (16%) including 1 admitted to the intensive care unit. A total of 6 cases (15%) were categorized as severe coronavirus disease 2019 with nearly all patients being either overweight or obese before pregnancy or with asthma or other comorbidities. Of the 8 deliveries that occurred during the study period, there was 1 preterm birth at 33 weeks' gestation to improve pulmonary status in a woman with class III obesity, and 1 stillbirth of unknown etiology.

CONCLUSION:

Severe coronavirus disease 2019 developed in approximately 15% of pregnant patients and occurred primarily in overweight or obese women with underlying conditions. Obesity and coronavirus disease 2019 may synergistically increase risk for a medically indicated preterm birth to improve maternal pulmonary status in late pregnancy. These findings support categorizing pregnant patients as a higher-risk group, particularly those with chronic comorbidities.

Full text: Available Collection: International databases Database: MEDLINE Type: Article Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: Am J Obstet Gynecol Clinical aspect: Etiology / Prognosis Year: 2020

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Full text: Available Collection: International databases Database: MEDLINE Type: Article Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: Am J Obstet Gynecol Clinical aspect: Etiology / Prognosis Year: 2020