Adverse Perinatal Outcomes in a Large US Birth Cohort During the COVID-19 Pandemic : Adverse Perinatal Outcomes During COVID-19

ABSTRACT:

Objective

To investigate whether coronavirus disease 2019 (COVID-19) is associated with adverse perinatal outcomes in a large national dataset and to examine rates of adverse outcomes during the pandemic compared to pre-pandemic period.

Methods

This observational cohort study included 683,905 patients, between the ages of 12-50, hospitalized for childbirth and abortion between January 1, 2019 and May 31, 2021. During the pre-pandemic period, 271,444 women were hospitalized for childbirth. During the pandemic, 308,532 women were hospitalized for childbirth and 2,708 had COVID-19. Associations between COVID-19 and in-hospital adverse perinatal outcomes were examined using propensity score-adjusted logistic regression.

Results

Compared to women without COVID-19, women with COVID-19 were more likely to experience both early and late preterm birth (aOR 1.38 [95% CI 1.1-1.7], aOR 1.62 [95% CI 1.3-1.7], respectively), preeclampsia (aOR 1.2 [95% CI 1.0-1.4]), disseminated intravascular coagulopathy (DIC) (aOR 1.57 [95% CI 1.1-2.2]), pulmonary edema (aOR 2.7 [95% CI 1.1- 6.3]), and need for mechanical ventilation (aOR 8.1 [95% CI 3.8-17.3]). There was no significant difference in the prevalence of stillbirth among women with (n= 16 / 2,708) and without (n= 174 / 39,562) COVID-19, p=0.257. There were no differences in adverse outcomes among women who delivered during the pandemic versus pre-pandemic period. Combined in-hospital mortality was significantly higher for women with COVID-19 (147 [95% CI 3.0 -292] vs 2.5 [95% CI 0-7.5] deaths per 100,000 women). Women diagnosed with COVID-19 within 30 days prior to hospitalization were more likely to experience early preterm birth, placental abruption, and mechanical ventilation, compared to women diagnosed with COVID-19 > 30 days prior to hospitalization for childbirth (4.0% vs. 2.4% for early preterm birth, aOR 1.7 [95% CI 1.1-2.7]; 2.2% vs. 1.2% for placental abruption, aOR 1.86 [95% CI 1.0 - 3.4]); 0.9% vs. 0.1% for mechanical ventilation, aOR 13.7 [95% CI 1.8-107.2])).

Conclusion

Women with COVID-19 had a higher prevalence of adverse perinatal outcomes and increased in-hospital mortality, with highest risk occurring when diagnosis was within 30 days of hospitalization, raising the possibility of a high-risk period.

SUBMITTER: Litman E 

PROVIDER: S-EPMC8805913 | biostudies-literature |

REPOSITORIES: biostudies-literature