Risk Factors and Clinical Outcomes Associated With Acute Respiratory Distress Syndrome in Pregnant and Non-pregnant Women Diagnosed With COVID-19: A Comparative Analysis.

Abstract

We aim to compare risk factors and clinical outcomes of acute respiratory distress syndrome (ARDS) associated with coronavirus disease 2019 (COVID-19) in pregnant versus non-pregnant women of reproductive age. This retrospective study included all women (18-45 years) with ARDS and confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)infection admitted during the study period from May 2020 to July 2021. Pregnant women were considered as case and non-pregnant women as control. Primary outcomes included ventilatory support, the need for high-flow nasal oxygenation (HFNO), severe ARDS, and death. Secondary outcomes included intensive care unit (ICU) admission, length of hospital stay, and requirement of oxygen at discharge. We included 59 women diagnosed with ARDS and confirmed SARS-CoV-2 infection, of them 12 were pregnant and 47 were non-pregnant. The non-pregnant women were significantly older than pregnant women (28.7±5 versus 35.5±8.2, p=0.008). Presenting symptoms were comparable among the groups. Diabetes was significantly higher in the non-pregnant group (8.3% versus 31.9%, p<0.02). Pregnant women had a significantly higher range of D-dimer (5.8±7.2 versus 1.8±1.9, p<0.01) and interleukin-6 (IL-6) (212.0±300.8 versus 49.7±57.7, p<0.011) and lower platelet count (129.4±120.1 versus 197.6±92.9, p<0.05) compared to non-pregnant women. Pregnant women were more likely to experience primary outcomes includingthe need for HFNO (33% versus 8.5%, odds ratio (OR): 5.3, p<0.02) and death (50% versus 31.9%, OR: 2.1, p<0.04) compared to non-pregnant women. Pregnant women with severe COVID-19 and ARDS were at an increased risk for experiencing ICU admission, intubation, and mechanical ventilation compared to age-matched non-pregnant women, although comorbidities such as diabetes were higher among the non-pregnant cohort. These findings suggest that pregnancy itself is a potential risk factor for complications and morbidities among women with severe COVID-19.