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Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection.
JAMA Netw Open. 2020 11 02; 3(11):e2029256.JN

Abstract

Importance

Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19).

Objectives

To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes.

Design, Setting, and Participants

This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity.

Exposures

SARS-CoV-2 infection during pregnancy.

Main Outcomes and Measures

The primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Maternal illness severity, neonatal infection, and placental abnormalities were described.

Results

From March 18 through August 22, 2020, 3374 pregnant women (mean [SD] age, 27.6 [6] years) tested for SARS-CoV-2 were delivered, including 252 who tested positive for SARS-CoV-2 and 3122 who tested negative. The cohort included 2520 Hispanic (75%), 619 Black (18%), and 125 White (4%) women. There were no differences in age, parity, body mass index, or diabetes among women with or without SARS-CoV-2. SARS-CoV-2 positivity was more common among Hispanic women (230 [91%] positive vs 2290 [73%] negative; difference, 17.9%; 95% CI, 12.3%-23.5%; P < .001). There was no difference in the composite primary outcome (52 women [21%] vs 684 women [23%]; relative risk, 0.94; 95% CI, 0.73-1.21; P = .64). Early neonatal SARS-CoV-2 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women. There were no placental pathologic differences by illness severity. Maternal illness at initial presentation was asymptomatic or mild in 239 women (95%), and 6 of those women (3%) developed severe or critical illness. Fourteen women (6%) were hospitalized for the indication of COVID-19.

Conclusions and Relevance

In a large, single-institution cohort study, SARS-CoV-2 infection during pregnancy was not associated with adverse pregnancy outcomes. Neonatal infection may be as high as 3% and may occur predominantly among asymptomatic or mildly symptomatic women. Placental abnormalities were not associated with disease severity, and hospitalization frequency was similar to rates among nonpregnant women.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas. Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas.Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas. Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas.Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas. Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas.Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas.Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas.Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas.Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas. Women and Infants Specialty Health, Parkland Health and Hospital System, Dallas, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33211113

Citation

Adhikari, Emily H., et al. "Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection." JAMA Network Open, vol. 3, no. 11, 2020, pp. e2029256.
Adhikari EH, Moreno W, Zofkie AC, et al. Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Netw Open. 2020;3(11):e2029256.
Adhikari, E. H., Moreno, W., Zofkie, A. C., MacDonald, L., McIntire, D. D., Collins, R. R. J., & Spong, C. Y. (2020). Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Network Open, 3(11), e2029256. https://doi.org/10.1001/jamanetworkopen.2020.29256
Adhikari EH, et al. Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection. JAMA Netw Open. 2020 11 2;3(11):e2029256. PubMed PMID: 33211113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pregnancy Outcomes Among Women With and Without Severe Acute Respiratory Syndrome Coronavirus 2 Infection. AU - Adhikari,Emily H, AU - Moreno,Wilmer, AU - Zofkie,Amanda C, AU - MacDonald,Lorre, AU - McIntire,Donald D, AU - Collins,Rebecca R J, AU - Spong,Catherine Y, Y1 - 2020/11/02/ PY - 2020/11/19/entrez PY - 2020/11/20/pubmed PY - 2020/11/20/medline SP - e2029256 EP - e2029256 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 11 N2 - Importance: Published data suggest that there are increased hospitalizations, placental abnormalities, and rare neonatal transmission among pregnant women with coronavirus disease 2019 (COVID-19). Objectives: To evaluate adverse outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy and to describe clinical management, disease progression, hospital admission, placental abnormalities, and neonatal outcomes. Design, Setting, and Participants: This observational cohort study of maternal and neonatal outcomes among delivered women with and without SARS-CoV-2 during pregnancy was conducted from March 18 through August 22, 2020, at Parkland Health and Hospital System (Dallas, Texas), a high-volume prenatal clinic system and public maternity hospital with widespread access to SARS-CoV-2 testing in outpatient, emergency department, and inpatient settings. Women were included if they were tested for SARS-CoV-2 during pregnancy and delivered. For placental analysis, the pathologist was blinded to illness severity. Exposures: SARS-CoV-2 infection during pregnancy. Main Outcomes and Measures: The primary outcome was a composite of preterm birth, preeclampsia with severe features, or cesarean delivery for abnormal fetal heart rate among women delivered after 20 weeks of gestation. Maternal illness severity, neonatal infection, and placental abnormalities were described. Results: From March 18 through August 22, 2020, 3374 pregnant women (mean [SD] age, 27.6 [6] years) tested for SARS-CoV-2 were delivered, including 252 who tested positive for SARS-CoV-2 and 3122 who tested negative. The cohort included 2520 Hispanic (75%), 619 Black (18%), and 125 White (4%) women. There were no differences in age, parity, body mass index, or diabetes among women with or without SARS-CoV-2. SARS-CoV-2 positivity was more common among Hispanic women (230 [91%] positive vs 2290 [73%] negative; difference, 17.9%; 95% CI, 12.3%-23.5%; P < .001). There was no difference in the composite primary outcome (52 women [21%] vs 684 women [23%]; relative risk, 0.94; 95% CI, 0.73-1.21; P = .64). Early neonatal SARS-CoV-2 infection occurred in 6 of 188 tested infants (3%), primarily born to asymptomatic or mildly symptomatic women. There were no placental pathologic differences by illness severity. Maternal illness at initial presentation was asymptomatic or mild in 239 women (95%), and 6 of those women (3%) developed severe or critical illness. Fourteen women (6%) were hospitalized for the indication of COVID-19. Conclusions and Relevance: In a large, single-institution cohort study, SARS-CoV-2 infection during pregnancy was not associated with adverse pregnancy outcomes. Neonatal infection may be as high as 3% and may occur predominantly among asymptomatic or mildly symptomatic women. Placental abnormalities were not associated with disease severity, and hospitalization frequency was similar to rates among nonpregnant women. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/33211113/Pregnancy_Outcomes_Among_Women_With_and_Without_Severe_Acute_Respiratory_Syndrome_Coronavirus_2_Infection_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.29256 DB - PRIME DP - Unbound Medicine ER -