Clinico-Radiological Features and Outcomes in Pregnant Women with COVID-19: Compared with Age-Matched Non-Pregnant Women

Abstract

Background: Limited data were available for profiling the COVID-19 in pregnant women and their neonates. This study aimed to investigate the clinico-radiological findings and outcomes in pregnant women with COVID-19 compared to age-matched non-pregnant women, and assess the status of the neonates. Methods: Clinical and CT data of 21 pregnant and 19 age-matched non-pregnant women with COVID-19 from January 23 to March 4, 2020 were retrospectively reviewed. Four stages of CT images in both groups were analyzed and compared based on the time intervals from symptom onset: stage 1 (0-6 days, n=40), stage 2 (7-9 days, n=27), stage 3 (10-16 days, n=22), and stage 4 (>16, n=28). The clinical features and outcomes of the neonates were also assessed. Findings: Compared with age-matched non-pregnant women, initial normal temperature (13/21, 62%), leukocytosis (11/21, 52%), elevated neutrophil ratio (18 /21, 86%), and normal lymphocyte count (11/21, 52%) were more frequent in pregnant group. Pure consolidation in lungs was more common at presentation in pregnant cases (P<0·001). Pregnant women progressed with a higher consolidation frequency compared with non-pregnant group in stage 2 (95% vs. 82%, P=0·001). Improvement was identified in stages 3 and 4 for both groups, but consolidation was still more frequent for pregnant women in stage 4 (P<0·001). None of patients developed critical COVID-19 pneumonia or died in either group. Preterm delivery occurred in 6 of 16 (38%) patients. The pregnancy complications included intrauterine distress (n=1) and premature rupture of membrane (n=3). No neonatal asphyxia or death was observed. No infant had clinical COVID-19 pneumonia and pharyngeal swab specimens from 11 of 17 infants were negative for the SARS-CoV-2. Interpretation: Clinical features were not characteristic in pregnant women who developed relatively more severe COVID-19 pneumonia at presentation with a slower recovery course. Perinatal COVID-19 infection could potentially superimpose the risks of complications upon the mothers and their fetuses. Fortunately, the health status of neonates indicated that there was no evidence of the maternal-to-fetal transmission of COVID-19 in women during late pregnancy. Funding Statement: This study is funded by Joint fund project of Hubei Health Commission (WJ2019H294), National Key Research and Development Program of China (No. 2017YFC0109003), and Shanghai Sailing Program (19YF1433100). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by the Institutional Ethics Committee of the two enrolled centers. The informed consent requirement was waived for this retrospective study.