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Epidemiology of coronavirus disease 2019 in pregnancy: risk factors and associations with adverse maternal and neonatal outcomes.
Brandt, Justin S; Hill, Jennifer; Reddy, Ajay; Schuster, Meike; Patrick, Haylea S; Rosen, Todd; Sauer, Mark V; Boyle, Carla; Ananth, Cande V.
  • Brandt JS; Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address: jsb288@rwjms.rutgers.edu.
  • Hill J; Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
  • Reddy A; Division of Neonatology, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
  • Schuster M; Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
  • Patrick HS; Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
  • Rosen T; Division of Maternal-Fetal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
  • Sauer MV; Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
  • Boyle C; Robert Wood Johnson University Hospital, New Brunswick, NJ.
  • Ananth CV; Division of Epidemiology and Biostatistics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medi
Am J Obstet Gynecol ; 224(4): 389.e1-389.e9, 2021 04.
Article in English | MEDLINE | ID: covidwho-871684
Semantic information from SemMedBD (by NLM)
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ABSTRACT

BACKGROUND:

Coronavirus disease 2019 may be associated with adverse maternal and neonatal outcomes in pregnancy, but there are few controlled data to quantify the magnitude of these risks or to characterize the epidemiology and risk factors.

OBJECTIVE:

This study aimed to quantify the associations of coronavirus disease 2019 with adverse maternal and neonatal outcomes in pregnancy and to characterize the epidemiology and risk factors. STUDY

DESIGN:

We performed a matched case-control study of pregnant patients with confirmed coronavirus disease 2019 cases who delivered between 16 and 41 weeks' gestation from March 11 to June 11, 2020. Uninfected pregnant women (controls) were matched to coronavirus disease 2019 cases on a 21 ratio based on delivery date. Maternal demographic characteristics, coronavirus disease 2019 symptoms, laboratory evaluations, obstetrical and neonatal outcomes, and clinical management were chart abstracted. The primary outcomes included (1) a composite of adverse maternal outcome, defined as preeclampsia, venous thromboembolism, antepartum admission, maternal intensive care unit admission, need for mechanical ventilation, supplemental oxygen, or maternal death, and (2) a composite of adverse neonatal outcome, defined as respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, 5-minute Apgar score of <5, persistent category 2 fetal heart rate tracing despite intrauterine resuscitation, or neonatal death. To quantify the associations between exposure to mild and severe or critical coronavirus disease 2019 and adverse maternal and neonatal outcomes, unadjusted and adjusted analyses were performed using conditional logistic regression (to account for matching), with matched-pair odds ratio and 95% confidence interval based on 1000 bias-corrected bootstrap resampling as the effect measure. Associations were adjusted for potential confounders.

RESULTS:

A total of 61 confirmed coronavirus disease 2019 cases were enrolled during the study period (mild disease, n=54 [88.5%]; severe disease, n=6 [9.8%]; critical disease, n=1 [1.6%]). The odds of adverse composite maternal outcome were 3.4 times higher among cases than controls (18.0% vs 8.2%; adjusted odds ratio, 3.4; 95% confidence interval, 1.2-13.4). The odds of adverse composite neonatal outcome were 1.7 times higher in the case group than to the control group (18.0% vs 13.9%; adjusted odds ratio, 1.7; 95% confidence interval, 0.8-4.8). Stratified analyses by disease severity indicated that the morbidity associated with coronavirus disease 2019 in pregnancy was largely driven by the severe or critical disease phenotype. Major risk factors for associated morbidity were black and Hispanic race, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019.

CONCLUSION:

Coronavirus disease 2019 during pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes, an association that is primarily driven by morbidity associated with severe or critical coronavirus disease 2019. Black and Hispanic race, obesity, advanced maternal age, medical comorbidities, and antepartum admissions related to coronavirus disease 2019 are risk factors for associated morbidity.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pregnancy Complications, Infectious / SARS-CoV-2 / COVID-19 Subject: Pregnancy Complications, Infectious / SARS-CoV-2 / COVID-19 Type of study: Case report / Etiology study / Observational study / Risk factors / Screening study Language: English Journal: Am J Obstet Gynecol Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pregnancy Complications, Infectious / SARS-CoV-2 / COVID-19 Subject: Pregnancy Complications, Infectious / SARS-CoV-2 / COVID-19 Type of study: Case report / Etiology study / Observational study / Risk factors / Screening study Language: English Journal: Am J Obstet Gynecol Year: 2021
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