tetano
Editor, Senior Moderator
Am J Obstet Gynecol MFM
. 2022 Aug 12;100715.
doi: 10.1016/j.ajogmf.2022.100715. Online ahead of print.
Characteristics and treatment of hospitalized pregnant women with Coronavirus Disease 2019, COVID-19
Ahlia Sekkarie[SUP] 1 [/SUP], Rebecca Woodruff[SUP] 2 [/SUP], Michael Whitaker[SUP] 3 [/SUP], Michael R Kramer[SUP] 4 [/SUP], Lauren B Zapata[SUP] 2 [/SUP], Sascha R Ellington[SUP] 3 [/SUP], Dana M Meaney-Delman[SUP] 3 [/SUP], Huong Pham[SUP] 3 [/SUP], Kadam Patel[SUP] 5 [/SUP], Christopher A Taylor[SUP] 3 [/SUP], Shua J Chai[SUP] 6 [/SUP], Breanna Kawasaki[SUP] 7 [/SUP], James Meek[SUP] 8 [/SUP], Kyle P Openo[SUP] 9 [/SUP], Andy Weigel[SUP] 10 [/SUP], Lauren Leegwater[SUP] 11 [/SUP], Kathryn Como-Sabetti[SUP] 12 [/SUP], Susan L Ropp[SUP] 13 [/SUP], Alison Muse[SUP] 14 [/SUP], Nancy M Bennett[SUP] 15 [/SUP], Laurie M Billing[SUP] 16 [/SUP], Melissa Sutton[SUP] 17 [/SUP], H Keipp Talbot[SUP] 18 [/SUP], Mary Hill[SUP] 19 [/SUP], Fiona P Havers[SUP] 2 [/SUP]
Affiliations
Abstract
Background: Pregnant women less frequently receive Coronavirus Disease 2019 (COVID-19) vaccination and are at increased risk for adverse pregnancy outcomes from COVID-19.
Objectives: First, describe the vaccination status, treatment, and outcomes of hospitalized, symptomatic pregnant women with COVID-19 and second, estimate whether treatment differs by pregnancy status among treatment-eligible (i.e., requiring supplemental oxygen per National Institutes of Health guidelines at the time of the study) women.
Study design: During January-November 2021, the COVID-19-Associated Hospitalization Surveillance Network completed medical chart abstraction for a probability sample of 2,715 hospitalized women aged 15-49 years with laboratory-confirmed SARS-CoV-2 infection. Of these, 1,950 women had symptoms of COVID-19 upon admission; 336 were pregnant. We calculated weighted prevalence estimates of demographic and clinical characteristics, vaccination status, and outcomes among pregnant women with symptoms of COVID-19 upon admission. We used propensity score matching to estimate prevalence ratios (PR), and 95% confidence intervals (CI) of treatment-eligible patients who received remdesivir or systemic steroids by pregnancy status.
Results: Among 336 hospitalized pregnant women with symptomatic COVID-19, 39.6% were non-Hispanic Black, 24.8% were Hispanic or Latino, and 61.9% were aged 25-34 years. Among those with known COVID-19 vaccination status, 92.9% were unvaccinated. One-third (32.7%) were treatment-eligible. Among treatment-eligible pregnant women, 74.1% received systemic steroids and 61.4% received remdesivir. Among those that were no longer pregnant at discharge (n=180), 5.4% had spontaneous abortions and 3.5% had stillbirths. Of the 159 live births, 29.0% were pre-term. Among a propensity score-matched cohort of treatment-eligible hospitalized women of reproductive age, pregnant women were less likely than non-pregnant women to receive remdesivir (PR: 0.82, 95% CI 0.69-0.97) and systemic steroids (PR: 0.80, 95% CI 0.73-0.87).
Conclusion: Most hospitalized pregnant patients with symptomatic COVID-19 were unvaccinated. Hospitalized pregnant patients were less likely to receive recommended remdesivir and systemic steroids compared to similar hospitalized non-pregnant women. Our results underscore the need to identify opportunities for improving COVID-19 vaccination, implementation of treatment of pregnant women, and the inclusion of pregnant women in clinical trials.
Keywords: SARS-CoV-2 steroids; remdesivir; stillbirth; surveillance; vaccination.
. 2022 Aug 12;100715.
doi: 10.1016/j.ajogmf.2022.100715. Online ahead of print.
Characteristics and treatment of hospitalized pregnant women with Coronavirus Disease 2019, COVID-19
Ahlia Sekkarie[SUP] 1 [/SUP], Rebecca Woodruff[SUP] 2 [/SUP], Michael Whitaker[SUP] 3 [/SUP], Michael R Kramer[SUP] 4 [/SUP], Lauren B Zapata[SUP] 2 [/SUP], Sascha R Ellington[SUP] 3 [/SUP], Dana M Meaney-Delman[SUP] 3 [/SUP], Huong Pham[SUP] 3 [/SUP], Kadam Patel[SUP] 5 [/SUP], Christopher A Taylor[SUP] 3 [/SUP], Shua J Chai[SUP] 6 [/SUP], Breanna Kawasaki[SUP] 7 [/SUP], James Meek[SUP] 8 [/SUP], Kyle P Openo[SUP] 9 [/SUP], Andy Weigel[SUP] 10 [/SUP], Lauren Leegwater[SUP] 11 [/SUP], Kathryn Como-Sabetti[SUP] 12 [/SUP], Susan L Ropp[SUP] 13 [/SUP], Alison Muse[SUP] 14 [/SUP], Nancy M Bennett[SUP] 15 [/SUP], Laurie M Billing[SUP] 16 [/SUP], Melissa Sutton[SUP] 17 [/SUP], H Keipp Talbot[SUP] 18 [/SUP], Mary Hill[SUP] 19 [/SUP], Fiona P Havers[SUP] 2 [/SUP]
Affiliations
- PMID: 35970493
- DOI: 10.1016/j.ajogmf.2022.100715
Abstract
Background: Pregnant women less frequently receive Coronavirus Disease 2019 (COVID-19) vaccination and are at increased risk for adverse pregnancy outcomes from COVID-19.
Objectives: First, describe the vaccination status, treatment, and outcomes of hospitalized, symptomatic pregnant women with COVID-19 and second, estimate whether treatment differs by pregnancy status among treatment-eligible (i.e., requiring supplemental oxygen per National Institutes of Health guidelines at the time of the study) women.
Study design: During January-November 2021, the COVID-19-Associated Hospitalization Surveillance Network completed medical chart abstraction for a probability sample of 2,715 hospitalized women aged 15-49 years with laboratory-confirmed SARS-CoV-2 infection. Of these, 1,950 women had symptoms of COVID-19 upon admission; 336 were pregnant. We calculated weighted prevalence estimates of demographic and clinical characteristics, vaccination status, and outcomes among pregnant women with symptoms of COVID-19 upon admission. We used propensity score matching to estimate prevalence ratios (PR), and 95% confidence intervals (CI) of treatment-eligible patients who received remdesivir or systemic steroids by pregnancy status.
Results: Among 336 hospitalized pregnant women with symptomatic COVID-19, 39.6% were non-Hispanic Black, 24.8% were Hispanic or Latino, and 61.9% were aged 25-34 years. Among those with known COVID-19 vaccination status, 92.9% were unvaccinated. One-third (32.7%) were treatment-eligible. Among treatment-eligible pregnant women, 74.1% received systemic steroids and 61.4% received remdesivir. Among those that were no longer pregnant at discharge (n=180), 5.4% had spontaneous abortions and 3.5% had stillbirths. Of the 159 live births, 29.0% were pre-term. Among a propensity score-matched cohort of treatment-eligible hospitalized women of reproductive age, pregnant women were less likely than non-pregnant women to receive remdesivir (PR: 0.82, 95% CI 0.69-0.97) and systemic steroids (PR: 0.80, 95% CI 0.73-0.87).
Conclusion: Most hospitalized pregnant patients with symptomatic COVID-19 were unvaccinated. Hospitalized pregnant patients were less likely to receive recommended remdesivir and systemic steroids compared to similar hospitalized non-pregnant women. Our results underscore the need to identify opportunities for improving COVID-19 vaccination, implementation of treatment of pregnant women, and the inclusion of pregnant women in clinical trials.
Keywords: SARS-CoV-2 steroids; remdesivir; stillbirth; surveillance; vaccination.