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Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study.
PLoS Med. 2021 11; 18(11):e1003857.PM

Abstract

BACKGROUND

To the best of our knowledge, no study has exhaustively evaluated the association between maternal morbidities and Coronavirus Disease 2019 (COVID-19) during the first wave of the pandemic in pregnant women. We investigated, in natural conceptions and assisted reproductive technique (ART) pregnancies, whether maternal morbidities were more frequent in pregnant women with COVID-19 diagnosis compared to pregnant women without COVID-19 diagnosis during the first wave of the COVID-19 pandemic.

METHODS AND FINDINGS

We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalizations for births ≥22 weeks of gestation in France from January to June 2020 using the French national hospitalization database (PMSI). Pregnant women with COVID-19 were identified if they had been recorded in the database using the ICD-10 (International Classification of Disease) code for presence of a hospitalization for COVID-19. A total of 244,645 births were included, of which 874 (0.36%) in the COVID-19 group. Maternal morbidities and adverse obstetrical outcomes among those with or without COVID-19 were analyzed with a multivariable logistic regression model adjusted on patient characteristics. Among pregnant women, older age (31.1 (±5.9) years old versus 30.5 (±5.4) years old, respectively, p < 0.001), obesity (0.7% versus 0.3%, respectively, p < 0.001), multiple pregnancy (0.7% versus 0.4%, respectively, p < 0.001), and history of hypertension (0.9% versus 0.3%, respectively, p < 0.001) were more frequent with COVID-19 diagnosis. Active smoking (0.2% versus 0.4%, respectively, p < 0.001) and primiparity (0.3% versus 0.4%, respectively, p < 0.03) were less frequent with COVID-19 diagnosis. Frequency of ART conception was not different between those with and without COVID-19 diagnosis (p = 0.28). When compared to the non-COVID-19 group, women in the COVID-19 group had a higher frequency of admission to ICU (5.9% versus 0.1%, p < 0.001), mortality (0.2% versus 0.005%, p < 0.001), preeclampsia/eclampsia (4.8% versus 2.2%, p < 0.001), gestational hypertension (2.3% versus 1.3%, p < 0.03), postpartum hemorrhage (10.0% versus 5.7%, p < 0.001), preterm birth at <37 weeks of gestation (16.7% versus 7.1%, p < 0.001), <32 weeks of gestation (2.2% versus 0.8%, p < 0.001), <28 weeks of gestation (2.4% versus 0.8%, p < 0.001), induced preterm birth (5.4% versus 1.4%, p < 0.001), spontaneous preterm birth (11.3% versus 5.7%, p < 0.001), fetal distress (33.0% versus 26.0%, p < 0.001), and cesarean section (33.0% versus 20.2%, p < 0.001). Rates of pregnancy terminations ≥22 weeks of gestation, stillbirths, gestational diabetes, placenta praevia, and placenta abruption were not significantly different between the COVID-19 and non-COVID-19 groups. The number of venous thromboembolic events was too low to perform statistical analysis. A limitation of this study relies in the possibility that asymptomatic infected women were not systematically detected.

CONCLUSIONS

We observed an increased frequency of pregnant women with maternal morbidities and diagnosis of COVID-19 compared to pregnant women without COVID-19. It appears essential to be aware of this, notably in populations at known risk of developing a more severe form of infection or obstetrical morbidities and in order for obstetrical units to better inform pregnant women and provide the best care. Although causality cannot be determined from these associations, these results may be in line with recent recommendations in favor of vaccination for pregnant women.

Authors+Show Affiliations

Centre d'Assistance Médicale à la Procréation, gynécologie obstétrique, médecine de la reproduction, hôpital Bichat Claude-Bernard, AP-HP, Nord, Université de Paris, Paris, France.Centre d'Assistance Médicale à la Procréation, gynécologie obstétrique, médecine de la reproduction, hôpital Bichat Claude-Bernard, AP-HP, Nord, Université de Paris, Paris, France.Unilabs, direction médicale, Clichy-La-Garenne, France.Université Bourgogne Franche-Comté-INSERM UMR1231, Dijon, France.Service de médecine et biologie de la reproduction, hôpital Saint-Joseph, Marseille, France.Inserm, équipe lipodystrophies génétiques et acquises, service de biologie de la reproduction-CECOS, Saint-Antoine research center, Sorbonne université, Paris, France. Hôpital Tenon, AP-HP, Sorbonne université, Paris, France.Hôpital Tenon, AP-HP, Sorbonne université, Paris, France.Hôpital Antoine Béclère, AP-HP, Université de Paris, Clamart, France.Agence de la Biomédecine, La Plaine Saint Denis, France.Agence de la Biomédecine, La Plaine Saint Denis, France.Agence de la Biomédecine, La Plaine Saint Denis, France.Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, AP-HP, Nord, Université de Paris, Paris, France. INSERM U1137, IAME, Faculté de Médecine site Bichat, Université de Paris, Paris, France.Agence de la Biomédecine, La Plaine Saint Denis, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34847147

Citation

Epelboin, Sylvie, et al. "Obstetrical Outcomes and Maternal Morbidities Associated With COVID-19 in Pregnant Women in France: a National Retrospective Cohort Study." PLoS Medicine, vol. 18, no. 11, 2021, pp. e1003857.
Epelboin S, Labrosse J, De Mouzon J, et al. Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study. PLoS Med. 2021;18(11):e1003857.
Epelboin, S., Labrosse, J., De Mouzon, J., Fauque, P., Gervoise-Boyer, M. J., Levy, R., Sermondade, N., Hesters, L., Bergère, M., Devienne, C., Jonveaux, P., Ghosn, J., & Pessione, F. (2021). Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study. PLoS Medicine, 18(11), e1003857. https://doi.org/10.1371/journal.pmed.1003857
Epelboin S, et al. Obstetrical Outcomes and Maternal Morbidities Associated With COVID-19 in Pregnant Women in France: a National Retrospective Cohort Study. PLoS Med. 2021;18(11):e1003857. PubMed PMID: 34847147.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study. AU - Epelboin,Sylvie, AU - Labrosse,Julie, AU - De Mouzon,Jacques, AU - Fauque,Patricia, AU - Gervoise-Boyer,Marie-José, AU - Levy,Rachel, AU - Sermondade,Nathalie, AU - Hesters,Laetitia, AU - Bergère,Marianne, AU - Devienne,Claire, AU - Jonveaux,Philippe, AU - Ghosn,Jade, AU - Pessione,Fabienne, Y1 - 2021/11/30/ PY - 2021/02/11/received PY - 2021/10/28/accepted PY - 2021/11/30/entrez PY - 2021/12/1/pubmed PY - 2021/12/1/medline SP - e1003857 EP - e1003857 JF - PLoS medicine JO - PLoS Med VL - 18 IS - 11 N2 - BACKGROUND: To the best of our knowledge, no study has exhaustively evaluated the association between maternal morbidities and Coronavirus Disease 2019 (COVID-19) during the first wave of the pandemic in pregnant women. We investigated, in natural conceptions and assisted reproductive technique (ART) pregnancies, whether maternal morbidities were more frequent in pregnant women with COVID-19 diagnosis compared to pregnant women without COVID-19 diagnosis during the first wave of the COVID-19 pandemic. METHODS AND FINDINGS: We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalizations for births ≥22 weeks of gestation in France from January to June 2020 using the French national hospitalization database (PMSI). Pregnant women with COVID-19 were identified if they had been recorded in the database using the ICD-10 (International Classification of Disease) code for presence of a hospitalization for COVID-19. A total of 244,645 births were included, of which 874 (0.36%) in the COVID-19 group. Maternal morbidities and adverse obstetrical outcomes among those with or without COVID-19 were analyzed with a multivariable logistic regression model adjusted on patient characteristics. Among pregnant women, older age (31.1 (±5.9) years old versus 30.5 (±5.4) years old, respectively, p < 0.001), obesity (0.7% versus 0.3%, respectively, p < 0.001), multiple pregnancy (0.7% versus 0.4%, respectively, p < 0.001), and history of hypertension (0.9% versus 0.3%, respectively, p < 0.001) were more frequent with COVID-19 diagnosis. Active smoking (0.2% versus 0.4%, respectively, p < 0.001) and primiparity (0.3% versus 0.4%, respectively, p < 0.03) were less frequent with COVID-19 diagnosis. Frequency of ART conception was not different between those with and without COVID-19 diagnosis (p = 0.28). When compared to the non-COVID-19 group, women in the COVID-19 group had a higher frequency of admission to ICU (5.9% versus 0.1%, p < 0.001), mortality (0.2% versus 0.005%, p < 0.001), preeclampsia/eclampsia (4.8% versus 2.2%, p < 0.001), gestational hypertension (2.3% versus 1.3%, p < 0.03), postpartum hemorrhage (10.0% versus 5.7%, p < 0.001), preterm birth at <37 weeks of gestation (16.7% versus 7.1%, p < 0.001), <32 weeks of gestation (2.2% versus 0.8%, p < 0.001), <28 weeks of gestation (2.4% versus 0.8%, p < 0.001), induced preterm birth (5.4% versus 1.4%, p < 0.001), spontaneous preterm birth (11.3% versus 5.7%, p < 0.001), fetal distress (33.0% versus 26.0%, p < 0.001), and cesarean section (33.0% versus 20.2%, p < 0.001). Rates of pregnancy terminations ≥22 weeks of gestation, stillbirths, gestational diabetes, placenta praevia, and placenta abruption were not significantly different between the COVID-19 and non-COVID-19 groups. The number of venous thromboembolic events was too low to perform statistical analysis. A limitation of this study relies in the possibility that asymptomatic infected women were not systematically detected. CONCLUSIONS: We observed an increased frequency of pregnant women with maternal morbidities and diagnosis of COVID-19 compared to pregnant women without COVID-19. It appears essential to be aware of this, notably in populations at known risk of developing a more severe form of infection or obstetrical morbidities and in order for obstetrical units to better inform pregnant women and provide the best care. Although causality cannot be determined from these associations, these results may be in line with recent recommendations in favor of vaccination for pregnant women. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/34847147/Obstetrical_outcomes_and_maternal_morbidities_associated_with_COVID_19_in_pregnant_women_in_France:_A_national_retrospective_cohort_study_ L2 - https://dx.plos.org/10.1371/journal.pmed.1003857 DB - PRIME DP - Unbound Medicine ER -