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Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore.
Ann Acad Med Singap. 2020 11; 49(11):857-869.AA

Abstract

INTRODUCTION

Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore.

METHODS

Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission.

RESULTS

Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5).

CONCLUSION

The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

33381779

Citation

Mattar, Citra Nz, et al. "Pregnancy Outcomes in COVID-19: a Prospective Cohort Study in Singapore." Annals of the Academy of Medicine, Singapore, vol. 49, no. 11, 2020, pp. 857-869.
Mattar CN, Kalimuddin S, Sadarangani SP, et al. Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore. Ann Acad Med Singap. 2020;49(11):857-869.
Mattar, C. N., Kalimuddin, S., Sadarangani, S. P., Tagore, S., Thain, S., Thoon, K. C., Hong, E. Y., Kanneganti, A., Ku, C. W., Chan, G. M., Lee, K. Z., Yap, J. J., Tan, S. S., Yan, B., Young, B. E., Lye, D. C., Anderson, D. E., Yang, L., Su, L. L., ... Chan, J. K. (2020). Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore. Annals of the Academy of Medicine, Singapore, 49(11), 857-869. https://doi.org/10.47102/annals-acadmedsg.2020437
Mattar CN, et al. Pregnancy Outcomes in COVID-19: a Prospective Cohort Study in Singapore. Ann Acad Med Singap. 2020;49(11):857-869. PubMed PMID: 33381779.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore. AU - Mattar,Citra Nz, AU - Kalimuddin,Shirin, AU - Sadarangani,Sapna P, AU - Tagore,Shephali, AU - Thain,Serene, AU - Thoon,Koh Cheng, AU - Hong,Eliane Y, AU - Kanneganti,Abhiram, AU - Ku,Chee Wai, AU - Chan,Grace Mf, AU - Lee,Kelvin Zx, AU - Yap,Jeannie Jy, AU - Tan,Shaun S, AU - Yan,Benedict, AU - Young,Barnaby E, AU - Lye,David C, AU - Anderson,Danielle E, AU - Yang,Liying, AU - Su,Lin Lin, AU - Somani,Jyoti, AU - Tan,Lay Kok, AU - Choolani,Mahesh A, AU - Chan,Jerry Ky, PY - 2020/12/31/entrez PY - 2021/1/1/pubmed PY - 2021/1/9/medline SP - 857 EP - 869 JF - Annals of the Academy of Medicine, Singapore JO - Ann Acad Med Singap VL - 49 IS - 11 N2 - INTRODUCTION: Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore. METHODS: Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission. RESULTS: Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5). CONCLUSION: The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta. SN - 0304-4602 UR - https://www.unboundmedicine.com/medline/citation/33381779/Pregnancy_Outcomes_in_COVID-19:_A_Prospective_Cohort_Study_in_Singapore L2 - http://www.annals.edu.sg/pdf/49VolNo11Nov2020/V49N11p857.pdf DB - PRIME DP - Unbound Medicine ER -