https://www.cidrap.umn.edu/covid-19...-more-likely-have-severe-illness-die-delivery
In 2020, pregnant COVID patients much more likely to have severe illness, die at delivery
Mary Van Beusekom, MS
Today at 2:40 p.m.
COVID-19
University of Southern California researchers retrospectively analyzed data from the Healthcare Cost and Utilization Project's National Inpatient Sample on 2,578,095 hospital deliveries at 2,691 centers from April to December 2020. The median patient age was 29 years, 50.7% were White, 20.6% were Hispanic, 14.7% were Black, and 5.7% were Asian.
Of all patients, 45,425 (17.6%) tested positive for COVID-19 at delivery at 1,704 (63.3%) of hospitals (median per-hospital COVID-19 case load, 15). The top 10% of hospitals by volume cared for at least 60 infected pregnant patients.
A multivariable analysis showed that the risk factors for COVID-19 infection were younger age, delivery in the later months of the study period, Black and Hispanic race, low income, obesity, underlying medical conditions, homelessness, Northeastern region, earlier gestational age, and admission to a large urban hospital.
Severe illness less likely to be recognized
COVID-positive pregnant women at delivery were more likely than uninfected patients to become severely ill (46.4% vs 18.8%; adjusted odds ratio [aOR], 2.60;95% confidence interval [CI], 2.39 to 2.82), with a greater need for tracheostomy and ventilation and a higher risk of respiratory distress syndrome, heart attack, sepsis, shock, cardiac arrest, and blood clots. A failure to recognize and respond to a severely ill patient was also more common among pregnant COVID-19 patients than among uninfected pregnant women (1.5% vs 0.2%; aOR, 5.56; 95% CI, 2.51 to 12.30).
A failure to recognize and respond to a severely ill patient was also more common among pregnant COVID-19 patients than among uninfected pregnant women.
The risk of death among COVID-infected pregnant women at delivery was roughly 14 times higher than among their uninfected counterparts (64.0 vs 4.3 per 100,000 deliveries; aOR, 13.91; 95% CI, 6.36 to 30.42). The median time to death was 16 days. The COVID-19 case-fatality rate fell as the pandemic progressed, from 232.9 to 79.1 per 100,000 deliveries.
The authors noted their lack of data on COVID-19 severity and treatment, neonatal outcomes, delivery type, and cause of death.
"Despite these limitations, the evaluation of the initial pandemic period in this study demonstrates the substantial morbidity and mortality of COVID-19 in pregnant patients and highlights the importance of prevention of COVID-19 in this population," they wrote. "Further investigation to assess the generalizability in the subsequent vaccine era is warranted."
In 2020, pregnant COVID patients much more likely to have severe illness, die at delivery
Mary Van Beusekom, MS
Today at 2:40 p.m.
COVID-19
Pregnant women in the United States infected with COVID-19 at delivery early in the pandemic were nearly three times more likely to become severely ill—and 14 times more likely to die—than their uninfected peers, according to a national study published late last week in JAMA Network Open.University of Southern California researchers retrospectively analyzed data from the Healthcare Cost and Utilization Project's National Inpatient Sample on 2,578,095 hospital deliveries at 2,691 centers from April to December 2020. The median patient age was 29 years, 50.7% were White, 20.6% were Hispanic, 14.7% were Black, and 5.7% were Asian.
Of all patients, 45,425 (17.6%) tested positive for COVID-19 at delivery at 1,704 (63.3%) of hospitals (median per-hospital COVID-19 case load, 15). The top 10% of hospitals by volume cared for at least 60 infected pregnant patients.
A multivariable analysis showed that the risk factors for COVID-19 infection were younger age, delivery in the later months of the study period, Black and Hispanic race, low income, obesity, underlying medical conditions, homelessness, Northeastern region, earlier gestational age, and admission to a large urban hospital.
Severe illness less likely to be recognized
COVID-positive pregnant women at delivery were more likely than uninfected patients to become severely ill (46.4% vs 18.8%; adjusted odds ratio [aOR], 2.60;95% confidence interval [CI], 2.39 to 2.82), with a greater need for tracheostomy and ventilation and a higher risk of respiratory distress syndrome, heart attack, sepsis, shock, cardiac arrest, and blood clots. A failure to recognize and respond to a severely ill patient was also more common among pregnant COVID-19 patients than among uninfected pregnant women (1.5% vs 0.2%; aOR, 5.56; 95% CI, 2.51 to 12.30).
A failure to recognize and respond to a severely ill patient was also more common among pregnant COVID-19 patients than among uninfected pregnant women.
The risk of death among COVID-infected pregnant women at delivery was roughly 14 times higher than among their uninfected counterparts (64.0 vs 4.3 per 100,000 deliveries; aOR, 13.91; 95% CI, 6.36 to 30.42). The median time to death was 16 days. The COVID-19 case-fatality rate fell as the pandemic progressed, from 232.9 to 79.1 per 100,000 deliveries.
The authors noted their lack of data on COVID-19 severity and treatment, neonatal outcomes, delivery type, and cause of death.
"Despite these limitations, the evaluation of the initial pandemic period in this study demonstrates the substantial morbidity and mortality of COVID-19 in pregnant patients and highlights the importance of prevention of COVID-19 in this population," they wrote. "Further investigation to assess the generalizability in the subsequent vaccine era is warranted."