Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study

• Published in: PLoS medicine 2021-11, Vol.18 (11), p.e1003857-e1003857
• Main Authors: Epelboin, Sylvie, Labrosse, Julie, De Mouzon, Jacques, Fauque, Patricia, Gervoise-Boyer, Marie-José, Levy, Rachel, Sermondade, Nathalie, Hesters, Laetitia, Bergère, Marianne, Devienne, Claire, Jonveaux, Philippe, Ghosn, Jade, Pessione, Fabienne
• Format: Article
• Language: English
• Subjects: Asymptomatic; Birth; Cesarean section; Codes; Cohort analysis; Comorbidity; Coronaviruses; COVID-19; Diabetes mellitus; Diagnosis; Epidemics; Fetuses; Gestation; Health aspects; Hemorrhage; Hospitalization; Hospitals; Human health and pathology; Hypertension; Infections; Life Sciences; Maternal & child health; Morbidity; Pandemics; Patients; Placenta; Pneumonia; Pre-eclampsia; Preeclampsia; Pregnancy; Pregnant women; Premature birth; Public health; Reproduction; Risk factors; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Statistics; Stillbirth; Thromboembolism; Vaccination; Womens health
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1003857

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. We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalizations for births [greater than or equal to]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). 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.