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Am J Obstet Gynecol MFM
. 2021 Feb 20;100329.
doi: 10.1016/j.ajogmf.2021.100329. Online ahead of print.
Maternal and perinatal outcomes in high vs low risk-pregnancies affected by SARS-COV-2 infection (Phase-2): The WAPM (World Association of Perinatal Medicine) working group on COVID-19
Francesco D'Antonio 1 , Cihat Sen 2 , Daniele DI Mascio 3 , Alberto Galindo 4 , Cecilia Villalain 4 , Ignacio Herraiz 4 , Resul Arısoy 5 , Ali Ovayolu 6 , Hasan Eroğlu 6 , Manuel Guerra Canales 7 , Subhashini Ladella 8 , Liviu Cojocaru 9 , Ozhan Turan 9 , Sifa Turan 9 , Eran Hadar 10 , Noa A Brzezinski-Sinai 10 , Sarah Dollinger 10 , Ozlem Uyaniklar 11 , Sakine Rahimli Ocakouglu 11 , Zeliha Atak 11 , Tanja Premru-Srsen 12 , Lilijana Kornhauser-Cerar 12 , Mirjam Druškovič 12 , Liana Ples 13 , Reyhan G?nd?z 14 , Elif Ağa?ayak 14 , Javier Alfonso Schvartzman 15 , Mercedes Negri Malbran 15 , Marco Liberati 16 , Francesca Di Sebastiano 16 , Ludovica Oronzi 16 , Chiara Cerra 16 , Danilo Buca 16 , Angelo Cagnacci 17 , Arianna Ramone 17 , Fabio Barra 17 , Andrea Carosso 18 , Chiara Benedetto 18 , Stefano Cosma 18 , Axelle Pintiaux 19 , Caroline Daelemans 19 , Elena Costa 19 , Ayşeg?l ?zel 20 , Murat Muh?u 20 , Jes?s S Jimenez Lopez 21 , Clara Alvarado 22 , Anna Luengo Piqueras 23 , Dolores Esteban Oliva 23 , Giovanni Battista Luca Schera 24 , Nicola Volpe 24 , Tiziana Frusca 24 , Igor Samardjiski 25 , Slagjana Simeonova 25 , Irena Aleksioska Papestiev 25 , Javier Hojman 26 , Ilgin Turkcuoglu 27 , Antonella Cromi 28 , Antonio Simone Lagan? 28 , Fabio Ghezzi 28 , Angelo Sirico 29 , Alessandra Familiari 29 , Giovanni Scambia 29 , Zulfiya Khodjaeva Gennady T Sukhikh 30 , Ksenia A Gorina 30 , Renato Augusto Moreira de Sa 31 , Mariana Vaz 31 , Otto Henrique May Feuerschuette 32 , Anna Nunzia Della Gatta 33 , Aly Youssef 33 , Gaetana Di Donna 33 , Alicia Martinez-Varea 34 , Gabriela Loscalzo 34 , Jos? Morales Rosell? 34 , Vedran Stefanovic 35 , Irmeli Nupponen 35 , Kaisa Nelskyl? 35 , Rodrigo Ayala 36 , Rebeca Garrote Molpeceres 37 , Asunci?n Pino V?zquez 37 , Fabrizio Sandri 38 , Ilaria Cataneo 38 , Marinella Lenzi 38 , Esra Tustas Haberal 39 , Erasmo Huertas 40 , Amadeo Sanchez 40 , Pedro Arango 40 , Amanda Bermejo 41 , Mar?a Monica Gonzalez Alcantara 42 , G?khan G?yn?mer 43 , Erhan Okuyan 44 , Ciuhodaru Madalina 45 , Ana Concheiro Guisan 46 , Alejandra Mart?nez Schulte 47 , Valentina Esposito 48 , Valentina De Robertis 49 , Snezana Zdjelar 50 , Milan Lackovic 50 , Sladjana Mihajlovic 50 , Nelly Jekova 51 , Gabriele Saccone 52 , Mehmet Musa Aslan 53 , Maria Carmela Di Dedda 54 , Maisuri Chalid 55 , Jose Enrique Moros Canache 56 , George Daskalakis 57 , Panos Antsaklis 57 , Enrique Criado Vega 58 , Elisa Cueto 59 , Chiara Taccaliti 60 , Alicia Yeliz Aykanat 61 , Şerife ?zlem Gen? 62 , Bernd Froessler 63 , Petya Angelova Radulova 64 , Danila Morano 65 , Beatrice Bianchi 65 , Maria Giulia Lombana Marino 65 , Gabriella Meccariello 66 , Bindu Rohatgi 67 , Antonio Schiattarella 68 , Maddalena Morlando 68 , Nicola Colacurci 68 , Andrea Villasco 69 , Nicoletta Biglia 69 , Ana Luiza Santos Marques 70 , Alessandra Gatti 71 , Daniela Luvero 71 , Roberto Angioli 71 , Alejandro Pittaro 72 , Albert Lila 73 , Blanka Zlatohl?vkov? 74
Affiliations
- PMID: 33621713
- DOI: 10.1016/j.ajogmf.2021.100329
Abstract
Objectives: To evaluate maternal and perinatal outcomes in high compared to low-risk pregnancies complicated by SARS-COV-2 infection.
Methods: This was a multinational retrospective cohort study including women with laboratory-confirmed SARS-COV-2 from 76 centers from 25 different countries in Europe, United States, South America, Asia and Australia from 04 April 2020 till 28 October 2020. The primary outcome was a composite measure of maternal mortality and morbidity including admission to intensive care unit (ICU), use of mechanical ventilation, or death. Secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal (NND) and perinatal (PND) death, and admission to neonatal intensive care unit. All these outcomes were assessed in high-risk compared to low-risk pregnancies. Pregnancies were considered as high risk in case of either pre-existing chronic medical conditions pre-existing pregnancy or obstetric disorders occurring in pregnancy. Fisher-test and logistic regression analysis were used to analyze the data.
Results: 887 singleton pregnancies tested positive to SARS-COV-2 at RT-PCR nasal and pharyngeal swab were included in the study. The risk of composite adverse maternal outcome was higher in high compared to low risk-pregnancies with an OR of 1.52 (95% CU 1.03-2.24; p= 0.035). Likewise, women carrying a high risk-pregnancies were also at higher risk of hospital admission (OR: 1.48, 95% CI 1.07-2.04; p= 0.002), presence of severe respiratory symptoms (OR: 2.13, 95% CI .41-3.21; p= 0.001), admission to ICU (OR: 2.63, 95% CI 1.42-4.88) and invasive mechanical ventilation (OR: 2.65, 95% CI 1.19- 5.94; p= .002). When exploring perinatal outcomes, high-risk pregnancies were also at high risk of adverse perinatal outcome with an OR 0f 1.78 (95% CI .15-2.72; p= 0.009). However, such association was mainly due to the higher incidence of miscarriage in high risk compared to low risk pregnancies (5.3% vs 1.6%, p= 0.008), while there was no difference as regard as the other explored outcomes between the two study groups. At logistic regression analysis, maternal age (OR: 1.12, 95% CI 1.02-1.22, p= 0.023) and the presence of a high-risk pregnancies (OR: 4.21, 95% CI 3.90-5.11, p<0.001) were independently associated with adverse maternal outcome.
Conclusions: High-risk pregnancies complicated by SARS-COV-2 infection are at higher risk of adverse maternal outcome compared to low-risk gestations.
Keywords: COVID19; Coronavirus; SARS-COV-2; infection; pregnancy.