Abstract
BackgroundTo 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 findingsWe 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.ConclusionsWe 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.
Highlights
On December 31, 2019, a cluster of pneumonia cases of unknown cause in Wuhan, China was reported to the World Health Organization (WHO) [1]
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 COVID19 diagnosis during the first wave of the COVID-19 pandemic
Nationale Informatique et Liberte; COVID-19, Coronavirus Disease 2019; ICU, intensive care unit; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; SNDS, Système National des Donnees de Sante; VTE, venous thromboembolism; WHO, World Health these associations, these results may be in line with recent recommendations in favor of vaccination for pregnant women
Summary
On December 31, 2019, a cluster of pneumonia cases of unknown cause in Wuhan, China was reported to the World Health Organization (WHO) [1]. Further investigations identified this infection as resulting from a new form of coronavirus, later identified by WHO as Coronavirus Disease 2019 (COVID-19), initially referred to as 2019-nCoV (2019-new coronavirus disease) and subsequently as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Most infected patients have mild pneumonia, COVID-19 can result in more severe disease, including hospitalization, admission to an intensive care unit (ICU), and death [2]. In France, the first confirmed case was reported on January 14, 2020. As an attempt to contain the virus, beginning on this date, all patients with confirmed COVID-19 were hospitalized, regardless of their medical condition. Starting from March 15, 2020, admission in a hospital was not systematic but was based on the medical condition. In France, tests were only available in every public and private clinic starting from April 2020, becoming systematic for all hospitalizations and births. The completeness of all COVID-19 diagnoses was not possible at the beginning of the first wave of the pandemic due to a lack of tests available
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