Risk factors for severe and critical Covid-19 in pregnant women in a single center in Brazil

Abstract

Background Risk factors for severe SARS-CoV2 infection in pregnancy have not been extensively studied. This information can help guide the management of pregnant women with COVID-19. Objective Examine risk factors for severe COVID-19 in pregnant women. Methods We reviewed the records of all pregnant women with positive SARS-CoV2 tests (qRT-PCR) managed at a single tertiary private maternity in Sao Paulo, Brazil. We categorized women as having non-severe (mild or moderate) or severe (severe or critical) COVID-19. We conducted multivariable analyses to identify differences in sociodemographic and clinical characteristics of the two groups as risk factors for severe COVID-19. Results Between March 13 and June 7 2020, 114 women tested positive for SARS-CoV-2; 80.7% (n = 92) had non-severe disease (69 mild, 23 moderate), 15.7% (n = 18) had severe, and 3.5% (n = 4) had critical COVID-19. Women with severe/critical COVID-19 (n = 22) were significantly older (35.0 ± 5.9 × 31.8 ± 5.1 years, p = 0.011), more likely to have at least one medical comorbidity (81.8% × 52.2%, p = .011) or a history of asthma (18.2% × 3.3%, p = .025), and tended to have a higher median body mass index (30.1 kg/m2, IQR 28.1–33.9 × 28.6, IQR 26.2–32.0, p = .056) than women with non-severe disease. Multivariate logistic regression analysis identified four factors as independent predictors of severe/critical COVID-19: asthma (OR 34.469, 95% CI 1.151–78.030, p = .026), non-white ethnicity (OR 7.932, 95% CI 1.311–47.973, p = .024), maternal age with a best cutoff of ≥ 34 years (OR 1.195, 95% CI 1.001–1.427, p = .048) and gestational age at diagnosis with a best cut-off of ≥ 35 weeks (OR 0.876, 95% CI 0.780–0.983, p = .025). The predictive value of the model including all variables was 0.823 (p < .001). Conclusion A history of asthma, non-white ethnicity, and older maternal age were risk factors for, while higher gestational age was protective against severe/critical COVID-19 in pregnant Brazilian women.