Pregnant women with severe or critical coronavirus disease 2019 have increased composite morbidity compared with nonpregnant matched controls

• Published in: American journal of obstetrics and gynecology 2021-05, Vol.224 (5), p.510.e1-510.e12
• Main Authors: DeBolt, Chelsea A., Bianco, Angela, Limaye, Meghana A., Silverstein, Jenna, Penfield, Christina A., Roman, Ashley S., Rosenberg, Henri M., Ferrara, Lauren, Lambert, Calvin, Khoury, Rasha, Bernstein, Peter S., Burd, Julia, Berghella, Vincenzo, Kaplowitz, Elianna, Overbey, Jessica R., Stone, Joanne
• Format: Article
• Language: English
• Subjects: Adult; coronavirus; COVID-19 - complications; COVID-19 - mortality; critical disease; disease course; Female; Humans; Infant, Newborn; intensive care; Intensive Care Units; intubation; Length of Stay; maternal morbidity; Middle Aged; Morbidity; Original Research; pandemic; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnant Women; preterm birth; respiratory distress syndrome; Retrospective Studies; SARS-CoV-2; severe acute respiratory syndrome; severe acute respiratory syndrome coronavirus 2; severe disease; Severity of Illness Index
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2020.11.022

In March 2020, as community spread of severe acute respiratory syndrome coronavirus 2 became increasingly prevalent, pregnant women seemed to be equally susceptible to developing coronavirus disease 2019. Although the disease course usually appears mild, severe and critical cases of coronavirus disease 2019 seem to lead to substantial morbidity, including intensive care unit admission with prolonged hospital stay, intubation, mechanical ventilation, and even death. Although there are recent reports regarding the impact of coronavirus disease 2019 on pregnancy, there is a lack of information regarding the severity of coronavirus disease 2019 in pregnant vs nonpregnant women. We aimed to describe the outcomes of severe and critical cases of coronavirus disease 2019 in pregnant vs nonpregnant, reproductive-aged women. This is a multicenter, retrospective, case-control study of women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection hospitalized with severe or critical coronavirus disease 2019 in 4 academic medical centers in New York City and 1 in Philadelphia between March 12, 2020, and May 5, 2020. The cases consisted of pregnant women admitted specifically for severe or critical coronavirus disease 2019 and not for obstetrical indications. The controls consisted of reproductive-aged, nonpregnant women admitted for severe or critical coronavirus disease 2019. The primary outcome was a composite morbidity that includes the following: death, a need for intubation, extracorporeal membrane oxygenation, noninvasive positive pressure ventilation, or a need for high-flow nasal cannula O2 supplementation. The secondary outcomes included intensive care unit admission, length of stay, a need for discharge to long-term acute care facilities, and discharge with a home O2 requirement. A total of 38 pregnant women with severe acute respiratory syndrome coronavirus 2 polymerase chain reaction-confirmed infections were admitted to 5 institutions specifically for coronavirus disease 2019, 29 (76.3%) meeting the criteria for severe disease status and 9 (23.7%) meeting the criteria for critical disease status. The mean age and body mass index were markedly higher in the nonpregnant control group. The nonpregnant cohort also had an increased frequency of preexisting medical comorbidities, including diabetes, hypertension, and coronary artery disease. The pregnant women were more likely to experience the primary outcome when compared with the n