Pregnant women with COVID-19 are more likely to have complications with pregnancy and birth than those without, according to a University of Paris study in PLOS Medicine.
The study looks at hospitalisation for births in France during the first six months of the pandemic and suggests that vaccination may be useful to protect mothers and their babies, particularly for women at a higher risk of developing severe COVID-19 infections.
Although causality cannot be established from our study, these findings raise the possibility that vaccination, which can be offered to pregnant women starting from the second trimester according to recommendations of several health authorities, may be useful to protect women from obstetrical excess risk, in particular in high-risk populations.
Few studies have looked at associations between COVID-19 and pregnancy outcomes, particularly during the first wave in early 2020. Sylvie Epelboin and colleagues from the Universite de Paris analysed data for French hospitalisations for birth after 22 weeks gestation in France between January and June 2020. Until 15 March, all confirmed cases of COVID were hospitalised but after this hospital admission was based on the medical condition of the patient. Of 244,465 births in hospital, 874 or 0.36% of mothers had been diagnosed with COVID-19.
Women in the COVID-19 group were more likely to be older, have obesity, be carrying more than one baby, or have a history of high blood pressure compared with those without. The women with COVID-19 had a higher frequency of admission to ICU; death; pre-eclampsia and eclampsia; gestational hypertension; haemorrhage either before or after birth; very premature spontaneous or induced birth; and Caesarean section. Rates of pregnancy terminations, stillbirths, gestational diabetes, placenta previa, placental abruption, and blood clots were not increased.
Being aware of these complications is important for healthcare providers to support pregnant women and provide the best care. The authors believe that although causality cannot be established in this study, vaccination to protect pregnant women from COVID-19 may be useful, particularly for those in higher risk groups.
Study details
Obstetrical outcomes and maternal morbidities associated with COVID-19 in pregnant women in France: A national retrospective cohort study
Sylvie Epelboin, Julie Labrosse, Jacques De Mouzon, Patricia Fauque, Marie-José Gervoise-Boyer,Rachel Levy,Nathalie Sermondade, Laetitia Hesters, Marianne Bergère, Claire Devienne, Philippe Jonveaux, Jade Ghosn, Fabienne Pessione
Published in PLOS Medicine on 30 November 2021
Abstract
Background
To 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 findings
We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalisations for births ≥22 weeks of gestation in France from January to June 2020 using the French national hospitalisation 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 hospitalisation 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 analysed 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), foetal distress (33.0% versus 26.0%, p < 0.001), and Caesarean 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.
Conclusions
We 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 favoor of vaccination for pregnant women.
What do these findings mean?
• These findings suggest that pregnant women with COVID-19 disease may have an increased risk of obstetrical morbidities when compared to non-COVID-19 pregnant controls.
• Results of this study may inform prevention and treatment policies for pregnant women with COVID-19.
• In clinical practice, it appears essential to be aware of these complications, 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 established from our study, these findings raise the possibility that vaccination, which can be offered to pregnant women starting from the second trimester according to recommendations of several health authorities, may be useful to protect women from obstetrical excess risk, in particular in high-risk populations.
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