April 29, 2020

Pregnant women with COVID-19 have comparable clinical outcomes with reproductive-aged non-pregnant women

Pregnant women have comparable clinical course and outcomes compared with reproductive-aged non-pregnant women when infected with SARS-CoV-2, according to a study published in the International Journal of Infectious Diseases. 

The study also concluded that no evidence supported vertical transmission of COVID-19 in the late stage of pregnancy including vaginal delivery.

Xu Qiancheng, The Central Hospital of Wuhan, Wuhan, China, and colleagues retrospectively reviewed medical records of pregnant and reproductive-aged non-pregnant women hospitalized with COVID-19 from January 15 to March 15, 2020. The severity of disease, virus clearance time, and length of hospital stay were measured as the primary interest and the vertical transmission potential of COVID-19 was also assessed.

The study enrolled 82 patients (28 pregnant women, 54 reproductive-aged non-pregnant women) with laboratory confirmed COVID-19. The median age of pregnant women was 30 (interquartile range [IQR] = 26.75-32) years that was similar to that of non-pregnant women of 31 (IQR = 28-35) years. The median gestational age of the pregnant women on admission was 38 (IQR = 36.5-39) weeks. Comorbidities were not frequently reported in both groups.

According to study data, the severity of disease was comparable in the two groups. Apart from 2 (7.1%) patients in pregnant women presented as mild type, most patients were categorized as moderate pneumonia (24 in pregnant women (85.7%) vs. 53 in non-pregnant women (98.1%)) and only 2 (7.1%) patients in pregnant women and 1 (1.9%) in non-pregnant women were classified as severe pneumonia. 

Univariate regression indicated no association between pregnancy and the severity of disease (odds ratio [OR] = 0.73; 95% confidence interval [CI], 0.08-5.15; p = 0.76), virus clearance time (hazard ratio [HR] 1.16; 95% CI, 0.65-2.01; p = 0.62), and length of hospital stay (HR 1.10, 95% CI 0.66-1.84; p = 0.71). 

Of those pregnant women, 3 (10.7%) were in the first trimester, 1 (3.6%) in the second trimester and 24 (85.7%) in the third trimester. All pregnant women in the first and second trimester terminated pregnancy due to concerns of radiological examination and COVID-19. Two pregnant women in early third trimester continued pregnancy (30, and 33 gestational weeks, respectively). There were 22 pregnant women who delivered 23 live births either by cesarean section (17, 60.7%) or vaginal delivery (5, 17.9%) and no neonate was infected with SARS-CoV-2. The authors noted that the potential of vertical transmission is still uncertain due to the limited data and further study is warranted.

The authors noted several limitations including the majority of the patients included were presented as mild to moderate, which limited the interpretation of the results, and that more severe patients might be admitted to other hospitals, other than the study hospital.

The authors also added that all the pregnant women who delivered were infected with SARS-CoV-2 in the late stage of pregnancy, and the probability of vertical transmission during the early trimesters could not be assessed. 

SOURCE: International Journal of Infectious Diseases