tetano
Editor, Senior Moderator
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[SUP] 1 [/SUP], Cihat Sen[SUP] 2 [/SUP], Daniele DI Mascio[SUP] 3 [/SUP], Alberto Galindo[SUP] 4 [/SUP], Cecilia Villalain[SUP] 4 [/SUP], Ignacio Herraiz[SUP] 4 [/SUP], Resul Arısoy[SUP] 5 [/SUP], Ali Ovayolu[SUP] 6 [/SUP], Hasan Eroğlu[SUP] 6 [/SUP], Manuel Guerra Canales[SUP] 7 [/SUP], Subhashini Ladella[SUP] 8 [/SUP], Liviu Cojocaru[SUP] 9 [/SUP], Ozhan Turan[SUP] 9 [/SUP], Sifa Turan[SUP] 9 [/SUP], Eran Hadar[SUP] 10 [/SUP], Noa A Brzezinski-Sinai[SUP] 10 [/SUP], Sarah Dollinger[SUP] 10 [/SUP], Ozlem Uyaniklar[SUP] 11 [/SUP], Sakine Rahimli Ocakouglu[SUP] 11 [/SUP], Zeliha Atak[SUP] 11 [/SUP], Tanja Premru-Srsen[SUP] 12 [/SUP], Lilijana Kornhauser-Cerar[SUP] 12 [/SUP], Mirjam Druškovič[SUP] 12 [/SUP], Liana Ples[SUP] 13 [/SUP], Reyhan G?nd?z[SUP] 14 [/SUP], Elif Ağa?ayak[SUP] 14 [/SUP], Javier Alfonso Schvartzman[SUP] 15 [/SUP], Mercedes Negri Malbran[SUP] 15 [/SUP], Marco Liberati[SUP] 16 [/SUP], Francesca Di Sebastiano[SUP] 16 [/SUP], Ludovica Oronzi[SUP] 16 [/SUP], Chiara Cerra[SUP] 16 [/SUP], Danilo Buca[SUP] 16 [/SUP], Angelo Cagnacci[SUP] 17 [/SUP], Arianna Ramone[SUP] 17 [/SUP], Fabio Barra[SUP] 17 [/SUP], Andrea Carosso[SUP] 18 [/SUP], Chiara Benedetto[SUP] 18 [/SUP], Stefano Cosma[SUP] 18 [/SUP], Axelle Pintiaux[SUP] 19 [/SUP], Caroline Daelemans[SUP] 19 [/SUP], Elena Costa[SUP] 19 [/SUP], Ayşeg?l ?zel[SUP] 20 [/SUP], Murat Muh?u[SUP] 20 [/SUP], Jes?s S Jimenez Lopez[SUP] 21 [/SUP], Clara Alvarado[SUP] 22 [/SUP], Anna Luengo Piqueras[SUP] 23 [/SUP], Dolores Esteban Oliva[SUP] 23 [/SUP], Giovanni Battista Luca Schera[SUP] 24 [/SUP], Nicola Volpe[SUP] 24 [/SUP], Tiziana Frusca[SUP] 24 [/SUP], Igor Samardjiski[SUP] 25 [/SUP], Slagjana Simeonova[SUP] 25 [/SUP], Irena Aleksioska Papestiev[SUP] 25 [/SUP], Javier Hojman[SUP] 26 [/SUP], Ilgin Turkcuoglu[SUP] 27 [/SUP], Antonella Cromi[SUP] 28 [/SUP], Antonio Simone Lagan?[SUP] 28 [/SUP], Fabio Ghezzi[SUP] 28 [/SUP], Angelo Sirico[SUP] 29 [/SUP], Alessandra Familiari[SUP] 29 [/SUP], Giovanni Scambia[SUP] 29 [/SUP], Zulfiya Khodjaeva Gennady T Sukhikh[SUP] 30 [/SUP], Ksenia A Gorina[SUP] 30 [/SUP], Renato Augusto Moreira de Sa[SUP] 31 [/SUP], Mariana Vaz[SUP] 31 [/SUP], Otto Henrique May Feuerschuette[SUP] 32 [/SUP], Anna Nunzia Della Gatta[SUP] 33 [/SUP], Aly Youssef[SUP] 33 [/SUP], Gaetana Di Donna[SUP] 33 [/SUP], Alicia Martinez-Varea[SUP] 34 [/SUP], Gabriela Loscalzo[SUP] 34 [/SUP], Jos? Morales Rosell?[SUP] 34 [/SUP], Vedran Stefanovic[SUP] 35 [/SUP], Irmeli Nupponen[SUP] 35 [/SUP], Kaisa Nelskyl?[SUP] 35 [/SUP], Rodrigo Ayala[SUP] 36 [/SUP], Rebeca Garrote Molpeceres[SUP] 37 [/SUP], Asunci?n Pino V?zquez[SUP] 37 [/SUP], Fabrizio Sandri[SUP] 38 [/SUP], Ilaria Cataneo[SUP] 38 [/SUP], Marinella Lenzi[SUP] 38 [/SUP], Esra Tustas Haberal[SUP] 39 [/SUP], Erasmo Huertas[SUP] 40 [/SUP], Amadeo Sanchez[SUP] 40 [/SUP], Pedro Arango[SUP] 40 [/SUP], Amanda Bermejo[SUP] 41 [/SUP], Mar?a Monica Gonzalez Alcantara[SUP] 42 [/SUP], G?khan G?yn?mer[SUP] 43 [/SUP], Erhan Okuyan[SUP] 44 [/SUP], Ciuhodaru Madalina[SUP] 45 [/SUP], Ana Concheiro Guisan[SUP] 46 [/SUP], Alejandra Mart?nez Schulte[SUP] 47 [/SUP], Valentina Esposito[SUP] 48 [/SUP], Valentina De Robertis[SUP] 49 [/SUP], Snezana Zdjelar[SUP] 50 [/SUP], Milan Lackovic[SUP] 50 [/SUP], Sladjana Mihajlovic[SUP] 50 [/SUP], Nelly Jekova[SUP] 51 [/SUP], Gabriele Saccone[SUP] 52 [/SUP], Mehmet Musa Aslan[SUP] 53 [/SUP], Maria Carmela Di Dedda[SUP] 54 [/SUP], Maisuri Chalid[SUP] 55 [/SUP], Jose Enrique Moros Canache[SUP] 56 [/SUP], George Daskalakis[SUP] 57 [/SUP], Panos Antsaklis[SUP] 57 [/SUP], Enrique Criado Vega[SUP] 58 [/SUP], Elisa Cueto[SUP] 59 [/SUP], Chiara Taccaliti[SUP] 60 [/SUP], Alicia Yeliz Aykanat[SUP] 61 [/SUP], Şerife ?zlem Gen?[SUP] 62 [/SUP], Bernd Froessler[SUP] 63 [/SUP], Petya Angelova Radulova[SUP] 64 [/SUP], Danila Morano[SUP] 65 [/SUP], Beatrice Bianchi[SUP] 65 [/SUP], Maria Giulia Lombana Marino[SUP] 65 [/SUP], Gabriella Meccariello[SUP] 66 [/SUP], Bindu Rohatgi[SUP] 67 [/SUP], Antonio Schiattarella[SUP] 68 [/SUP], Maddalena Morlando[SUP] 68 [/SUP], Nicola Colacurci[SUP] 68 [/SUP], Andrea Villasco[SUP] 69 [/SUP], Nicoletta Biglia[SUP] 69 [/SUP], Ana Luiza Santos Marques[SUP] 70 [/SUP], Alessandra Gatti[SUP] 71 [/SUP], Daniela Luvero[SUP] 71 [/SUP], Roberto Angioli[SUP] 71 [/SUP], Alejandro Pittaro[SUP] 72 [/SUP], Albert Lila[SUP] 73 [/SUP], Blanka Zlatohl?vkov?[SUP] 74 [/SUP]
Affiliations
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.
. 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[SUP] 1 [/SUP], Cihat Sen[SUP] 2 [/SUP], Daniele DI Mascio[SUP] 3 [/SUP], Alberto Galindo[SUP] 4 [/SUP], Cecilia Villalain[SUP] 4 [/SUP], Ignacio Herraiz[SUP] 4 [/SUP], Resul Arısoy[SUP] 5 [/SUP], Ali Ovayolu[SUP] 6 [/SUP], Hasan Eroğlu[SUP] 6 [/SUP], Manuel Guerra Canales[SUP] 7 [/SUP], Subhashini Ladella[SUP] 8 [/SUP], Liviu Cojocaru[SUP] 9 [/SUP], Ozhan Turan[SUP] 9 [/SUP], Sifa Turan[SUP] 9 [/SUP], Eran Hadar[SUP] 10 [/SUP], Noa A Brzezinski-Sinai[SUP] 10 [/SUP], Sarah Dollinger[SUP] 10 [/SUP], Ozlem Uyaniklar[SUP] 11 [/SUP], Sakine Rahimli Ocakouglu[SUP] 11 [/SUP], Zeliha Atak[SUP] 11 [/SUP], Tanja Premru-Srsen[SUP] 12 [/SUP], Lilijana Kornhauser-Cerar[SUP] 12 [/SUP], Mirjam Druškovič[SUP] 12 [/SUP], Liana Ples[SUP] 13 [/SUP], Reyhan G?nd?z[SUP] 14 [/SUP], Elif Ağa?ayak[SUP] 14 [/SUP], Javier Alfonso Schvartzman[SUP] 15 [/SUP], Mercedes Negri Malbran[SUP] 15 [/SUP], Marco Liberati[SUP] 16 [/SUP], Francesca Di Sebastiano[SUP] 16 [/SUP], Ludovica Oronzi[SUP] 16 [/SUP], Chiara Cerra[SUP] 16 [/SUP], Danilo Buca[SUP] 16 [/SUP], Angelo Cagnacci[SUP] 17 [/SUP], Arianna Ramone[SUP] 17 [/SUP], Fabio Barra[SUP] 17 [/SUP], Andrea Carosso[SUP] 18 [/SUP], Chiara Benedetto[SUP] 18 [/SUP], Stefano Cosma[SUP] 18 [/SUP], Axelle Pintiaux[SUP] 19 [/SUP], Caroline Daelemans[SUP] 19 [/SUP], Elena Costa[SUP] 19 [/SUP], Ayşeg?l ?zel[SUP] 20 [/SUP], Murat Muh?u[SUP] 20 [/SUP], Jes?s S Jimenez Lopez[SUP] 21 [/SUP], Clara Alvarado[SUP] 22 [/SUP], Anna Luengo Piqueras[SUP] 23 [/SUP], Dolores Esteban Oliva[SUP] 23 [/SUP], Giovanni Battista Luca Schera[SUP] 24 [/SUP], Nicola Volpe[SUP] 24 [/SUP], Tiziana Frusca[SUP] 24 [/SUP], Igor Samardjiski[SUP] 25 [/SUP], Slagjana Simeonova[SUP] 25 [/SUP], Irena Aleksioska Papestiev[SUP] 25 [/SUP], Javier Hojman[SUP] 26 [/SUP], Ilgin Turkcuoglu[SUP] 27 [/SUP], Antonella Cromi[SUP] 28 [/SUP], Antonio Simone Lagan?[SUP] 28 [/SUP], Fabio Ghezzi[SUP] 28 [/SUP], Angelo Sirico[SUP] 29 [/SUP], Alessandra Familiari[SUP] 29 [/SUP], Giovanni Scambia[SUP] 29 [/SUP], Zulfiya Khodjaeva Gennady T Sukhikh[SUP] 30 [/SUP], Ksenia A Gorina[SUP] 30 [/SUP], Renato Augusto Moreira de Sa[SUP] 31 [/SUP], Mariana Vaz[SUP] 31 [/SUP], Otto Henrique May Feuerschuette[SUP] 32 [/SUP], Anna Nunzia Della Gatta[SUP] 33 [/SUP], Aly Youssef[SUP] 33 [/SUP], Gaetana Di Donna[SUP] 33 [/SUP], Alicia Martinez-Varea[SUP] 34 [/SUP], Gabriela Loscalzo[SUP] 34 [/SUP], Jos? Morales Rosell?[SUP] 34 [/SUP], Vedran Stefanovic[SUP] 35 [/SUP], Irmeli Nupponen[SUP] 35 [/SUP], Kaisa Nelskyl?[SUP] 35 [/SUP], Rodrigo Ayala[SUP] 36 [/SUP], Rebeca Garrote Molpeceres[SUP] 37 [/SUP], Asunci?n Pino V?zquez[SUP] 37 [/SUP], Fabrizio Sandri[SUP] 38 [/SUP], Ilaria Cataneo[SUP] 38 [/SUP], Marinella Lenzi[SUP] 38 [/SUP], Esra Tustas Haberal[SUP] 39 [/SUP], Erasmo Huertas[SUP] 40 [/SUP], Amadeo Sanchez[SUP] 40 [/SUP], Pedro Arango[SUP] 40 [/SUP], Amanda Bermejo[SUP] 41 [/SUP], Mar?a Monica Gonzalez Alcantara[SUP] 42 [/SUP], G?khan G?yn?mer[SUP] 43 [/SUP], Erhan Okuyan[SUP] 44 [/SUP], Ciuhodaru Madalina[SUP] 45 [/SUP], Ana Concheiro Guisan[SUP] 46 [/SUP], Alejandra Mart?nez Schulte[SUP] 47 [/SUP], Valentina Esposito[SUP] 48 [/SUP], Valentina De Robertis[SUP] 49 [/SUP], Snezana Zdjelar[SUP] 50 [/SUP], Milan Lackovic[SUP] 50 [/SUP], Sladjana Mihajlovic[SUP] 50 [/SUP], Nelly Jekova[SUP] 51 [/SUP], Gabriele Saccone[SUP] 52 [/SUP], Mehmet Musa Aslan[SUP] 53 [/SUP], Maria Carmela Di Dedda[SUP] 54 [/SUP], Maisuri Chalid[SUP] 55 [/SUP], Jose Enrique Moros Canache[SUP] 56 [/SUP], George Daskalakis[SUP] 57 [/SUP], Panos Antsaklis[SUP] 57 [/SUP], Enrique Criado Vega[SUP] 58 [/SUP], Elisa Cueto[SUP] 59 [/SUP], Chiara Taccaliti[SUP] 60 [/SUP], Alicia Yeliz Aykanat[SUP] 61 [/SUP], Şerife ?zlem Gen?[SUP] 62 [/SUP], Bernd Froessler[SUP] 63 [/SUP], Petya Angelova Radulova[SUP] 64 [/SUP], Danila Morano[SUP] 65 [/SUP], Beatrice Bianchi[SUP] 65 [/SUP], Maria Giulia Lombana Marino[SUP] 65 [/SUP], Gabriella Meccariello[SUP] 66 [/SUP], Bindu Rohatgi[SUP] 67 [/SUP], Antonio Schiattarella[SUP] 68 [/SUP], Maddalena Morlando[SUP] 68 [/SUP], Nicola Colacurci[SUP] 68 [/SUP], Andrea Villasco[SUP] 69 [/SUP], Nicoletta Biglia[SUP] 69 [/SUP], Ana Luiza Santos Marques[SUP] 70 [/SUP], Alessandra Gatti[SUP] 71 [/SUP], Daniela Luvero[SUP] 71 [/SUP], Roberto Angioli[SUP] 71 [/SUP], Alejandro Pittaro[SUP] 72 [/SUP], Albert Lila[SUP] 73 [/SUP], Blanka Zlatohl?vkov?[SUP] 74 [/SUP]
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.