tetano
Editor, Senior Moderator
Am J Obstet Gynecol
. 2022 Aug 23;S0002-9378(22)00680-9.
doi: 10.1016/j.ajog.2022.08.038. Online ahead of print.
Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: A sequential, prospective meta-analysis
Emily R Smith[SUP] 1 [/SUP], Erin Oakley[SUP] 1 [/SUP], Gargi Wable Grandner[SUP] 1 [/SUP], Gordon Rukundo[SUP] 2 [/SUP], Fouzia Farooq[SUP] 1 [/SUP], Kacey Ferguson[SUP] 1 [/SUP], Sasha Baumann[SUP] 1 [/SUP], Kristina Adams Waldorf[SUP] 3 [/SUP], Yalda Afshar[SUP] 4 [/SUP], Mia Ahlberg[SUP] 5 [/SUP], Homa Ahmadzia[SUP] 6 [/SUP], Victor Akelo[SUP] 7 [/SUP], Grace Aldrovandi[SUP] 8 [/SUP], Elisa Bevilacqua[SUP] 9 [/SUP], Nabal Bracero[SUP] 10 [/SUP], Justin S Brandt[SUP] 11 [/SUP], Natalie Broutet[SUP] 12 [/SUP], Jorge Carrillo[SUP] 13 [/SUP], Jeanne Conry[SUP] 14 [/SUP], Erich Cosmi[SUP] 15 [/SUP], Fatima Crispi[SUP] 16 [/SUP], Francesca Crovetto[SUP] 16 [/SUP], Maria Del Mar Gil[SUP] 17 [/SUP], Camille Delgado-López[SUP] 18 [/SUP], Hema Divakar[SUP] 19 [/SUP], Amanda J Driscoll[SUP] 20 [/SUP], Guillaume Favre[SUP] 21 [/SUP], Irene Fernandez Buhigas[SUP] 17 [/SUP], Valerie Flaherman[SUP] 22 [/SUP], Christopher Gale[SUP] 23 [/SUP], Christine L Godwin[SUP] 12 [/SUP], Sami Gottlieb[SUP] 12 [/SUP], Eduard Gratacós[SUP] 16 [/SUP], Siran He[SUP] 1 [/SUP], Olivia Hernandez[SUP] 24 [/SUP], Stephanie Jones[SUP] 25 [/SUP], Sheetal Joshi[SUP] 19 [/SUP], Erkan Kalafat[SUP] 26 [/SUP], Sammy Khagayi[SUP] 27 [/SUP], Marian Knight[SUP] 28 [/SUP], Karen Kotloff[SUP] 20 [/SUP], Antonio Lanzone[SUP] 29 [/SUP], Valentina Laurita Longo[SUP] 29 [/SUP], Kirsty Le Doare[SUP] 30 [/SUP], Christoph Lees[SUP] 31 [/SUP], Ethan Litman[SUP] 6 [/SUP], Erica M Lokken[SUP] 3 [/SUP], Shabir A Madhi[SUP] 25 [/SUP], Laura A Magee[SUP] 32 [/SUP], Raigam Jafet Martinez-Portilla[SUP] 33 [/SUP], Torri D Metz[SUP] 34 [/SUP], Emily S Miller[SUP] 35 [/SUP], Deborah Money[SUP] 36 [/SUP], Sakita Moungmaithong[SUP] 37 [/SUP], Edward Mullins[SUP] 38 [/SUP], Jean B Nachega[SUP] 39 [/SUP], Marta C Nunes[SUP] 25 [/SUP], Dickens Onyango[SUP] 40 [/SUP], Alice Panchaud[SUP] 41 [/SUP], Liona C Poon[SUP] 37 [/SUP], Daniel Raiten[SUP] 42 [/SUP], Lesley Regan[SUP] 43 [/SUP], Daljit Sahota[SUP] 37 [/SUP], Allie Sakowicz[SUP] 35 [/SUP], Jose Sanin-Blair[SUP] 44 [/SUP], Olof Stephansson[SUP] 5 [/SUP], Marleen Temmerman[SUP] 45 [/SUP], Anna Thorson[SUP] 12 [/SUP], Soe Soe Thwin[SUP] 12 [/SUP], Beth A Tippett Barr[SUP] 46 [/SUP], Jorge E Tolosa[SUP] 47 [/SUP], Niyazi Tug[SUP] 48 [/SUP], Miguel Valencia-Prado[SUP] 49 [/SUP], Silvia Visentin[SUP] 15 [/SUP], Peter von Dadelszen[SUP] 50 [/SUP], Clare Whitehead[SUP] 51 [/SUP], Mollie Wood[SUP] 52 [/SUP], Huixia Yang[SUP] 53 [/SUP], Rebecca Zavala[SUP] 1 [/SUP], James M Tielsch[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: This sequential, prospective meta-analysis (sPMA) sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to: disease severity, maternal morbidities, neonatal mortality and morbidity, adverse birth outcomes.
Data sources: We prospectively invited study investigators to join the sPMA via professional research networks beginning in March 2020.
Study eligibility criteria: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area.
Study appraisal and synthesis methods: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a two-stage meta-analysis.
Results: We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (pre-existing diabetes, hypertension, cardiovascular disease) versus those without were at higher risk for COVID-19 severity and pregnancy health outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% CI: 1.12, 2.71) more likely to be admitted to the ICU. Pregnant women who were underweight before pregnancy were at higher risk of ICU admission (RR 5.53, 95% CI: 2.27, 13.44), ventilation (RR 9.36, 95% CI: 3.87, 22.63), and pregnancy-related death (RR 14.10, 95% CI: 2.83, 70.36). Pre-pregnancy obesity was also a risk factor for severe COVID-19 outcomes including ICU admission (RR 1.81, 95% CI: 1.26,2.60), ventilation (RR 2.05, 95% CI: 1.20,3.51), any critical care (RR 1.89, 95% CI: 1.28,2.77), and pneumonia (RR 1.66, 95% CI: 1.18,2.33). Anemic pregnant women with COVID-19 also had increased risk of ICU admission (RR 1.63, 95% CI: 1.25, 2.11) and death (RR 2.36, 95% CI: 1.15, 4.81).
Conclusion: We found that pregnant women with comorbidities including diabetes, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly-known risk factors, including HIV infection, pre-pregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.
Keywords: Coronavirus Disease 2019; Maternal Mortality; Neonatal Mortality; Pneumonia; Pregnancy; Preterm Birth; SARS-CoV-2; Small-for-gestational Age.
. 2022 Aug 23;S0002-9378(22)00680-9.
doi: 10.1016/j.ajog.2022.08.038. Online ahead of print.
Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: A sequential, prospective meta-analysis
Emily R Smith[SUP] 1 [/SUP], Erin Oakley[SUP] 1 [/SUP], Gargi Wable Grandner[SUP] 1 [/SUP], Gordon Rukundo[SUP] 2 [/SUP], Fouzia Farooq[SUP] 1 [/SUP], Kacey Ferguson[SUP] 1 [/SUP], Sasha Baumann[SUP] 1 [/SUP], Kristina Adams Waldorf[SUP] 3 [/SUP], Yalda Afshar[SUP] 4 [/SUP], Mia Ahlberg[SUP] 5 [/SUP], Homa Ahmadzia[SUP] 6 [/SUP], Victor Akelo[SUP] 7 [/SUP], Grace Aldrovandi[SUP] 8 [/SUP], Elisa Bevilacqua[SUP] 9 [/SUP], Nabal Bracero[SUP] 10 [/SUP], Justin S Brandt[SUP] 11 [/SUP], Natalie Broutet[SUP] 12 [/SUP], Jorge Carrillo[SUP] 13 [/SUP], Jeanne Conry[SUP] 14 [/SUP], Erich Cosmi[SUP] 15 [/SUP], Fatima Crispi[SUP] 16 [/SUP], Francesca Crovetto[SUP] 16 [/SUP], Maria Del Mar Gil[SUP] 17 [/SUP], Camille Delgado-López[SUP] 18 [/SUP], Hema Divakar[SUP] 19 [/SUP], Amanda J Driscoll[SUP] 20 [/SUP], Guillaume Favre[SUP] 21 [/SUP], Irene Fernandez Buhigas[SUP] 17 [/SUP], Valerie Flaherman[SUP] 22 [/SUP], Christopher Gale[SUP] 23 [/SUP], Christine L Godwin[SUP] 12 [/SUP], Sami Gottlieb[SUP] 12 [/SUP], Eduard Gratacós[SUP] 16 [/SUP], Siran He[SUP] 1 [/SUP], Olivia Hernandez[SUP] 24 [/SUP], Stephanie Jones[SUP] 25 [/SUP], Sheetal Joshi[SUP] 19 [/SUP], Erkan Kalafat[SUP] 26 [/SUP], Sammy Khagayi[SUP] 27 [/SUP], Marian Knight[SUP] 28 [/SUP], Karen Kotloff[SUP] 20 [/SUP], Antonio Lanzone[SUP] 29 [/SUP], Valentina Laurita Longo[SUP] 29 [/SUP], Kirsty Le Doare[SUP] 30 [/SUP], Christoph Lees[SUP] 31 [/SUP], Ethan Litman[SUP] 6 [/SUP], Erica M Lokken[SUP] 3 [/SUP], Shabir A Madhi[SUP] 25 [/SUP], Laura A Magee[SUP] 32 [/SUP], Raigam Jafet Martinez-Portilla[SUP] 33 [/SUP], Torri D Metz[SUP] 34 [/SUP], Emily S Miller[SUP] 35 [/SUP], Deborah Money[SUP] 36 [/SUP], Sakita Moungmaithong[SUP] 37 [/SUP], Edward Mullins[SUP] 38 [/SUP], Jean B Nachega[SUP] 39 [/SUP], Marta C Nunes[SUP] 25 [/SUP], Dickens Onyango[SUP] 40 [/SUP], Alice Panchaud[SUP] 41 [/SUP], Liona C Poon[SUP] 37 [/SUP], Daniel Raiten[SUP] 42 [/SUP], Lesley Regan[SUP] 43 [/SUP], Daljit Sahota[SUP] 37 [/SUP], Allie Sakowicz[SUP] 35 [/SUP], Jose Sanin-Blair[SUP] 44 [/SUP], Olof Stephansson[SUP] 5 [/SUP], Marleen Temmerman[SUP] 45 [/SUP], Anna Thorson[SUP] 12 [/SUP], Soe Soe Thwin[SUP] 12 [/SUP], Beth A Tippett Barr[SUP] 46 [/SUP], Jorge E Tolosa[SUP] 47 [/SUP], Niyazi Tug[SUP] 48 [/SUP], Miguel Valencia-Prado[SUP] 49 [/SUP], Silvia Visentin[SUP] 15 [/SUP], Peter von Dadelszen[SUP] 50 [/SUP], Clare Whitehead[SUP] 51 [/SUP], Mollie Wood[SUP] 52 [/SUP], Huixia Yang[SUP] 53 [/SUP], Rebecca Zavala[SUP] 1 [/SUP], James M Tielsch[SUP] 1 [/SUP]
Affiliations
- PMID: 36027953
- PMCID: PMC9398561
- DOI: 10.1016/j.ajog.2022.08.038
Abstract
Objective: This sequential, prospective meta-analysis (sPMA) sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to: disease severity, maternal morbidities, neonatal mortality and morbidity, adverse birth outcomes.
Data sources: We prospectively invited study investigators to join the sPMA via professional research networks beginning in March 2020.
Study eligibility criteria: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area.
Study appraisal and synthesis methods: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a two-stage meta-analysis.
Results: We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (pre-existing diabetes, hypertension, cardiovascular disease) versus those without were at higher risk for COVID-19 severity and pregnancy health outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% CI: 1.12, 2.71) more likely to be admitted to the ICU. Pregnant women who were underweight before pregnancy were at higher risk of ICU admission (RR 5.53, 95% CI: 2.27, 13.44), ventilation (RR 9.36, 95% CI: 3.87, 22.63), and pregnancy-related death (RR 14.10, 95% CI: 2.83, 70.36). Pre-pregnancy obesity was also a risk factor for severe COVID-19 outcomes including ICU admission (RR 1.81, 95% CI: 1.26,2.60), ventilation (RR 2.05, 95% CI: 1.20,3.51), any critical care (RR 1.89, 95% CI: 1.28,2.77), and pneumonia (RR 1.66, 95% CI: 1.18,2.33). Anemic pregnant women with COVID-19 also had increased risk of ICU admission (RR 1.63, 95% CI: 1.25, 2.11) and death (RR 2.36, 95% CI: 1.15, 4.81).
Conclusion: We found that pregnant women with comorbidities including diabetes, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly-known risk factors, including HIV infection, pre-pregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.
Keywords: Coronavirus Disease 2019; Maternal Mortality; Neonatal Mortality; Pneumonia; Pregnancy; Preterm Birth; SARS-CoV-2; Small-for-gestational Age.