Risk factors among pregnant and postpartum women with COVID-19

In a recent study published in the American Journal of Obstetrics and Gynecology, researchers investigated the clinical risk factors associated with adverse outcomes among coronavirus disease 2019 (COVID-19)-infected women during pregnancy and postpartum.

Background

Several studies have highlighted that pregnant women are at a higher risk of experiencing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) complications, while those with comorbidities might be even more likely to suffer from adverse disease outcomes. Furthermore, some treatments and vaccines have been recommended to be administered only to individuals at the highest risk. However, currently, there is no global consensus regarding all the factors that signify risk. 

About the study

In the present sequential, prospective meta-analysis (sPMA), researchers identified all the risk factors among COVID-19-infected pregnant and postpartum women for adverse outcomes with respect to disease severities, maternal and neonatal morbidities, and adverse birth outcomes.

The team included studies such as single- or multi-site cohort studies and registries that enrolled pregnant and recently postpartum women who had either suspected or confirmed SARS-CoV-2 infection. These studies must have recruited a minimum of 25 women within a specified catchment area. The team utilized data related to patients whose onset of infection was observed for up to 42 days after pregnancy.

A total of 24 outcomes were assessed for the study. These outcomes were related to COVID-19 severity, maternal morbidities, neonatal and fetal mortality and morbidity, and adverse birth outcomes. In the case of neonatal and fetal mortality, maternal morbidities, and all birth outcomes, the study included only the cases with infection onset either during pregnancy or within seven days of pregnancy outcome. Additionally, nine high-priority maternal risk factors were identified by the sPMA steering committee and included comorbidities, age, nutritional status, parity, and COVID-19 symptomatic status.

The study cohort was divided into two age groups: the younger maternal age group aged between 15 and 19 years and the older maternal age group aged between 35 and 45. These cohorts were compared to a reference cohort, including women aged between 20 and 34.

Results

The study results showed that pregnant women infected with SARS-CoV-2 who also had comorbidities such as diabetes, cardiovascular diseases, and hypertension were at a higher risk of experiencing outcomes related to infection severity and pregnancy-related mortality. Notably, the mortality risk was approximately 3.79 times higher among pregnant women with pre-existing diabetes, 2.75 times higher among those with pre-existing hypertension, and 16.76 times among those having cardiovascular diseases in comparison to those who did not display these comorbidities.

Furthermore, SARS-CoV-2-infected pregnant women with one of these comorbidities were at a higher risk for maternal morbidities such as preeclampsia or eclampsia, placental abruption, hypertensive disorders of pregnancy, and any cesarean delivery. Women with cardiovascular disease or hypertension were more likely to have an intrapartum cesarean delivery. Babies born to COVID-19 infected mothers with any of these comorbidities were also at a higher risk of mortality and newborn intensive care unit (NICU) admission. These infants had a higher chance of being born preterm, small-for-gestational-age, and low birth weight.    

The team also found that human immunodeficiency virus (HIV) coinfection with COVID-19 during pregnancy significantly increased the risk of experiencing severe COVID-19 infection. Among SARS-CoV-2-infected pregnant women who had HIV had a 67% higher chance of being admitted to ICU and a 72% higher likelihood of requiring critical care. Such coinfected pregnant women were also more likely to undergo a cesarean delivery. Babies born to HIV and COVID-19 infected women were at a higher risk for perinatal mortality.

Furthermore, the study showed that COVID-19-infected pregnant women aged between 20 and 34 years were at a lower risk for eclampsia or preeclampsia than infected younger mothers aged between 15 and 19. Babies born to younger mothers were also at a higher risk for perinatal death, neonatal death, and stillbirth. Younger COVID-19-infected pregnant women also had a higher chance of experiencing adverse pregnancy outcomes such as moderate preterm birth, very low birth weight, and small-for-gestational-age.     

Additionally, the team found a higher risk for adverse outcomes associated with COVID-19 severity among pregnant women experiencing a symptomatic infection than those with asymptomatic infection. These adverse outcomes included admission to the ICU. Any critical care, and pneumonia. However, outcomes related to fetal and neonatal mortality and morbidity, maternal morbidity, and adverse birth outcomes were comparable across asymptomatic and symptomatic cohorts.  

Conclusion

The study findings showed that pregnant women having comorbidities such as hypertension, diabetes, and cardiovascular diseases were more likely to experience severe COVID-19-related outcomes, adverse birth outcomes, and maternal morbidities. While pregnant women are a high-risk population, special preference should be given to this subset for preventing and treating COVID-19.