Abstract

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.

Details

Title
Maternal outcomes and risk factors for COVID-19 severity among pregnant women
Author
Vouga Manon 1 ; Favre Guillaume 1 ; Martinez-Perez, Oscar 2 ; Pomar Leo 1 ; Acebal, Laura Forcen 3 ; Abascal-Saiz Alejandra 4 ; Rosa Vila, Hernandez Maria 5 ; Hcini Najeh 6 ; Lambert, Véronique 6 ; Gabriel, Carles 6 ; Sichitiu Joanna 7 ; Salomon, Laurent 8 ; Stirnemann Julien 8 ; Ville Yves 8 ; de Tejada Begoña Martinez 9 ; Goncé Anna 10 ; Hawkins-Villarreal Ameth 10 ; Castillo, Karen 10 ; Solsona Eduard Gratacos 10 ; Trigo Lucas 11 ; Cleary, Brian 12 ; Geary, Michael 13 ; Bartels, Helena 13 ; Al-Kharouf Feras 13 ; Malone, Fergal 13 ; Higgins, Mary 14 ; Keating, Niamh 15 ; Knowles, Susan 16 ; Poncelet Christophe 17 ; Ribeiro-do-Valle, Carolina Carvalho 18 ; Surita Fernanda 18 ; Dantas-Silva, Amanda 18 ; Borrelli, Carolina 18 ; Luz Adriana Gomes 18 ; Fuenzalida Javiera 19 ; Carvajal, Jorge 19 ; Canales Manuel Guerra 20 ; Hernandez, Olivia 21 ; Grechukhina Olga 22 ; Ko, Albert I 23 ; Reddy, Uma 23 ; Figueiredo, Rita 24 ; Moucho Marina 24 ; Pinto, Pedro Viana 24 ; De, Luca Carmen 25 ; De Santis Marco 25 ; de Campos Diogo Ayres 26 ; Martins Inês 26 ; Garabedian, Charles 27 ; Subtil Damien 27 ; Bohrer Betania 28 ; Da Rocha Oppermann Maria Lucia 29 ; Wender Maria Celeste Osorio 29 ; Schuler-Faccini Lavinia 30 ; Sanseverino Maria Teresa Vieira 30 ; Giugliani Camila 31 ; Friedrich, Luciana 28 ; Scherer, Mariana Horn 30 ; Mottet, Nicolas 32 ; Ducarme Guillaume 33 ; Pelerin Helene 34 ; Moreau, Chloe 34 ; Breton Bénédicte 35 ; Quibel Thibaud 36 ; Rozenberg, Patrick 36 ; Giannoni, Eric 1 ; Granado, Cristina 37 ; Monod Cécile 37 ; Mueller, Doris 37 ; Hoesli Irene 37 ; Bassler, Dirk 38 ; Heldstab Sandra 39 ; Kölble, Nicole Ochsenbein 40 ; Sentilhes Loïc 41 ; Charvet, Melissa 41 ; Deprest, Jan 42 ; Richter Jute 42 ; Van der Veeken Lennart 43 ; Eggel-Hort Béatrice 44 ; Plantefeve Gaetan 45 ; Derouich Mohamed 46 ; Calvache Albaro José Nieto 47 ; Lopez-Giron, Maria Camila 47 ; Burgos-Luna, Juan Manuel 47 ; Escobar-Vidarte, Maria Fernanda 47 ; Hecher Kurt 48 ; Tallarek Ann-Christin 48 ; Hadar Eran 49 ; Krajden, Haratz Karina 50 ; Amikam Uri 51 ; Malinger Gustavo 51 ; Maymon, Ron 52 ; Yogev Yariv 50 ; Schäffer Leonhard 53 ; Toussaint Arnaud 54 ; Rossier Marie-Claude 55 ; De Sa Renato Augusto Moreira 56 ; Grawe, Claudia 57 ; Aebi-Popp Karoline 58 ; Anda-Petronela, Radan 59 ; Raio Luigi 59 ; Surbek, Daniel 59 ; Böckenhoff, Paul 60 ; Strizek Brigitte 60 ; Kaufmann, Martin 61 ; Bloch, Andrea 62 ; Boulvain Michel 63 ; Johann Silke 64 ; Heldstab, Sandra Andrea 65 ; Bernasconi Monya Todesco 65 ; Grant, Gaston 66 ; Feki Anis 66 ; Muller, Brochut Anne-Claude 67 ; Giral Marylene 68 ; Sedille Lucie 68 ; Papadia Andrea 69 ; Brugger, Romina Capoccia 70 ; Weber, Brigitte 71 ; Fischer, Tina 72 ; Kahlert, Christian 73 ; Saines Karin Nielsen 74 ; Cambou, Mary 75 ; Kanellos Panagiotis 76 ; Chen, Xiang 77 ; Yin Mingzhu 78 ; Haessig Annina 79 ; Ackermann Sandrine 1 ; Baud, David 80 ; Panchaud, Alice 81 

1  University Hospital, Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne, Switzerland (GRID:grid.8515.9) (ISNI:0000 0001 0423 4662) 
2  Puerta de Hierro University Hospital, Obstetricia y Ginecologia, Madrid, Spain (GRID:grid.73221.35) (ISNI:0000 0004 1767 8416) 
3  12 de Octubre University Hospital, Obstetrics and Gynaecology Department, Madrid, Spain (GRID:grid.144756.5) (ISNI:0000 0001 1945 5329) 
4  La Paz Universitary Hospital, Madrid, Spain (GRID:grid.81821.32) (ISNI:0000 0000 8970 9163) 
5  Hospital Santa Caterina, Gerona, Spain (GRID:grid.413409.b) 
6  CHOG, Department of Obstetrics and Gynaecology, Saint-Laurent du Maroni, France (GRID:grid.413409.b) 
7  University Hospital, Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne, Switzerland (GRID:grid.8515.9) (ISNI:0000 0001 0423 4662); Hopital Necker-Enfants Malades, Obstétrique et de Médecine fœtale, Paris, France (GRID:grid.412134.1) (ISNI:0000 0004 0593 9113) 
8  Hopital Necker-Enfants Malades, Obstétrique et de Médecine fœtale, Paris, France (GRID:grid.412134.1) (ISNI:0000 0004 0593 9113) 
9  University Hospitals of Geneva, Obstetrics Division, Department of Pediatrics Gynecology and Obstetrics, Geneva, Switzerland (GRID:grid.150338.c) (ISNI:0000 0001 0721 9812) 
10  University of Barcelona, BCNatal Maternal-Fetal Medicine Service, Hospital Clínic, Barcelona, Spain (GRID:grid.5841.8) (ISNI:0000 0004 1937 0247) 
11  Hospital Clínic and Hospital Sant Joan de Déu, Fetal Medicine Research Center, Barcelona, Spain (GRID:grid.411160.3) (ISNI:0000 0001 0663 8628) 
12  The Rotunda Hospital, Service of Pharmacy, Dublin, Ireland (GRID:grid.416068.d) (ISNI:0000 0004 0617 7587) 
13  The Rotunda Hospital, Maternal-fetal Medicine, Dublin, Ireland (GRID:grid.416068.d) (ISNI:0000 0004 0617 7587) 
14  National Maternity Hospital, UCD Perinatal Research Centre, Dublin, Ireland (GRID:grid.415614.3) (ISNI:0000 0004 0617 7309) 
15  National Maternity Hospital, Maternal Medicine, Dublin, Ireland (GRID:grid.415614.3) (ISNI:0000 0004 0617 7309) 
16  National Maternity Hospital, Microbiology, Dublin, Ireland (GRID:grid.415614.3) (ISNI:0000 0004 0617 7309) 
17  Centre Hospitalier René Dubos, Obstetric and Gynecology Unit, Cergy-Pontoise, France (GRID:grid.440383.8) (ISNI:0000 0004 1765 1969) 
18  University of Campinas, Department of Obstetrics & Gynecology, Campinas, Brazil (GRID:grid.411087.b) (ISNI:0000 0001 0723 2494) 
19  Pontificia Universidad Católica de Chile, Maternal-Fetal Medicine, Department of Obstetrics, Escuela de Medicina, Santiago, Chile (GRID:grid.7870.8) (ISNI:0000 0001 2157 0406) 
20  Medicina Materno Fetal, Hospital San José, Santiago, Chile (GRID:grid.7870.8) 
21  Hospital Felix Bulnes Cerda, Santiago, Chile (GRID:grid.7870.8) 
22  Yale School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710) 
23  Yale of School of Public Health, Department of Epidemiology of Microbial Diseases, New Haven, USA (GRID:grid.47100.32) (ISNI:0000000419368710) 
24  Centro Hospitalar e Universitário São João, Serviço ginecologia e obstetrícia, Porto, Portugal (GRID:grid.47100.32) 
25  Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Teratology Information Service, Rome, Italy (GRID:grid.411075.6) (ISNI:0000 0004 1760 4193) 
26  Santa Maria University Hospital, Medical School, Lisbon, Portugal (GRID:grid.411265.5) (ISNI:0000 0001 2295 9747) 
27  Jeanne de Flandre University Hospital, Department of Obstetrics, Lille, France (GRID:grid.410463.4) (ISNI:0000 0004 0471 8845) 
28  Universidade Federal do Rio Grande do Sul, Pediatra e Neonatologista, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil (GRID:grid.8532.c) (ISNI:0000 0001 2200 7498) 
29  Universidade Federal do Rio Grande do Sul, Maternity Ward, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil (GRID:grid.8532.c) (ISNI:0000 0001 2200 7498) 
30  Universidade Federal do Rio Grande do Sul, Departamento de Genética, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil (GRID:grid.8532.c) (ISNI:0000 0001 2200 7498) 
31  Universidade Federal do Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil (GRID:grid.8532.c) (ISNI:0000 0001 2200 7498) 
32  Université de Franche Comté, Department of Obstetrics and Gynecology, Besançon, France (GRID:grid.7459.f) (ISNI:0000 0001 2188 3779) 
33  Centre Hospitalier Departemental de Vendée, Department of Obstetrics and Gynecology, La Roche sur Yon, France (GRID:grid.477015.0) (ISNI:0000 0004 1772 6836) 
34  Centre Hospitalier Départemental de Vendée, Clinical Research Department, La Roche sur Yon, France (GRID:grid.477015.0) (ISNI:0000 0004 1772 6836) 
35  Annecy Genevois Hospital, Department of Obstetrics and Gynecology, Annecy, France (GRID:grid.477015.0) 
36  Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Department of Gynecology and Obstetrics, Poissy, France (GRID:grid.477015.0) 
37  University Hospital Basel, Department of Obstetrics and Antenatal Care, Basel, Switzerland (GRID:grid.410567.1) 
38  UniversitätsSpital Zürich, Department of Neonatology, Zurich, Switzerland (GRID:grid.412004.3) (ISNI:0000 0004 0478 9977) 
39  University of Zurich, Department of Anthropology, Zurich, Switzerland (GRID:grid.7400.3) (ISNI:0000 0004 1937 0650) 
40  UniversitätsSpital Zürich, Clinic of Obstetrics, Zurich, Switzerland (GRID:grid.412004.3) (ISNI:0000 0004 0478 9977) 
41  Bordeaux University Hospital, Department of Obstetrics and Gynecology, Bordeaux, France (GRID:grid.42399.35) (ISNI:0000 0004 0593 7118) 
42  University Hospitals Leuven, Department of Obstetrics and Gynecology, Leuven, Belgium (GRID:grid.410569.f) (ISNI:0000 0004 0626 3338) 
43  Katholieke Universiteit Leuven, Department of Regeneration and Development, Leuven, Belgium (GRID:grid.5596.f) (ISNI:0000 0001 0668 7884) 
44  Sion Hospital, Obstetric and Gynecology Unit, Sion, Switzerland (GRID:grid.5596.f) 
45  Victor Dupouy Hospital, Service de Réanimation polyvalente et USC, Argenteuil, France (GRID:grid.5596.f) 
46  Victor Dupouy Hospital, Obstetrics Unit, Argenteuil, France (GRID:grid.5596.f) 
47  Universitary Hospital, Obstetrics and Gynecology Department, Fundacion Clinica Valle de Lili, Cali, Colombia (GRID:grid.477264.4) 
48  University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Fetal Medicine, Hamburg, Germany (GRID:grid.13648.38) (ISNI:0000 0001 2180 3484) 
49  Tel-Aviv University, Maternal-Fetal Medicine Unit, Rabin Medical Center, Tel Aviv, Israel (GRID:grid.12136.37) (ISNI:0000 0004 1937 0546) 
50  Lis Maternity Hospital, Division of Ultrasound in Obstetrics and Gynecology, Tel Aviv, Israel (GRID:grid.413449.f) (ISNI:0000 0001 0518 6922) 
51  Tel Aviv Sourasky Medical Center, Division of Ultrasound in ObGy, Tel Aviv, Israel (GRID:grid.413449.f) (ISNI:0000 0001 0518 6922) 
52  Tel Aviv University, Israeli Society of Obstetrics and Gynecology, Hasaf Harofe Medical Center, Tel Aviv, Israel (GRID:grid.12136.37) (ISNI:0000 0004 1937 0546) 
53  Affiliated Hospital of the University of Zurich, Obstetrics Cantonal Hospital of Baden, Baden, Switzerland (GRID:grid.7400.3) (ISNI:0000 0004 1937 0650) 
54  Intercantonal Hospital of Broye, Department of Gynecology and Obstetrics, Payerne, Switzerland (GRID:grid.7400.3) 
55  Hospital Riviera Chablais, Obstetrics and Gynecology, Rennaz, Switzerland (GRID:grid.7400.3) 
56  Federal Fluminense University, Maternal-Fetal Unit, Rio de Janeiro, Brazil (GRID:grid.411173.1) (ISNI:0000 0001 2184 6919) 
57  Gynecology Stadtspital Triemli Zürich, Department of Obstetrics, Zurich, Switzerland (GRID:grid.414526.0) (ISNI:0000 0004 0518 665X) 
58  University Hospital Bern, Department of Infectious Diseases, Bern, Switzerland (GRID:grid.411656.1) (ISNI:0000 0004 0479 0855) 
59  Inselspital, Department of Obstetrics and Gynecology, Bern, Switzerland (GRID:grid.411656.1) (ISNI:0000 0004 0479 0855) 
60  University Hospital Bonn, Department of Obstetrics and Prenatal Medicine, Bonn, Germany (GRID:grid.15090.3d) (ISNI:0000 0000 8786 803X) 
61  Spital Bülach, Obstetric and Gynecology Unit, Bülach, Switzerland (GRID:grid.15090.3d) 
62  Hopital du Jura, Obstetric and Gynecology Unit, Delémont, Switzerland (GRID:grid.15090.3d) 
63  GHOL Hôpital de Nyon, Pôle Department of Gynecology and Obstetrics, Nyon, Switzerland (GRID:grid.15090.3d) 
64  Standort Visp, Department of Obstetrics and Gynecology Spitalzentrum OBerwallis, Visp, Switzerland (GRID:grid.15090.3d) 
65  Frauenklinik, Kantonsspital Aarau, Aarau, Switzerland (GRID:grid.413357.7) (ISNI:0000 0000 8704 3732) 
66  HFR Fribourg Hospital, Department of Obstetrics and Gynecology, Fribourg, Switzerland (GRID:grid.413357.7) 
67  GynEcho Medical Practice, Fribourg, Switzerland (GRID:grid.413357.7) 
68  La Rochelle Hospital, Department of Obstetrics and Gynecology, La Rochelle, France (GRID:grid.413357.7) 
69  Ente Ospedaliero Cantonale of Lugano, Department of Obstetrics and Gynecology, Lugano, Switzerland (GRID:grid.469433.f) (ISNI:0000 0004 0514 7845) 
70  Department of Obstetrics and Gynecology Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland (GRID:grid.469433.f) 
71  Kantonsspital Obwalden (KSOW), Department of Obstetrics and Gynecology, Sarnen, Switzerland (GRID:grid.469433.f) 
72  Frauenklinik, Kantonsspital Saint Gall, Saint Gall, Switzerland (GRID:grid.469433.f) 
73  Kantonsspital Saint Gall, Infectious Diseases and Hospital Epidemiology, Saint Gall, Switzerland (GRID:grid.469433.f) 
74  David Geffen UCLA School of Medicine, Division of Infectious Diseases, Department of Pediatrics, Los Angeles, USA (GRID:grid.19006.3e) (ISNI:0000 0000 9632 6718) 
75  David Geffen UCLA School of Medicine, Cardiac Surgery Department, Los Angeles, USA (GRID:grid.19006.3e) (ISNI:0000 0000 9632 6718) 
76  Kantonsspital Uri, Department of Obstetrics and Gynecology, Altdorf, Switzerland (GRID:grid.19006.3e) 
77  Xiangya Hospital, Dermatology Unit, Changsha, China (GRID:grid.452223.0) (ISNI:0000 0004 1757 7615) 
78  Xiangya Hospital, Hunan Engineering Research Center of Gynecology and Obstetrics Disease, Changsha, China (GRID:grid.452223.0) (ISNI:0000 0004 1757 7615) 
79  Zuger Kantonsspital, Department of Obstetrics and Gynecology, Zug, Switzerland (GRID:grid.508842.3) (ISNI:0000 0004 0520 0183) 
80  University Hospital, Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, Lausanne, Switzerland (GRID:grid.8515.9) (ISNI:0000 0001 0423 4662); Centre Hospitalier Universitaire Vaudois (CHUV), Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, Lausanne, Switzerland (GRID:grid.8515.9) (ISNI:0000 0001 0423 4662) 
81  University of Bern, Institute of Primary Health Care (BIHAM), Bern, Switzerland (GRID:grid.5734.5) (ISNI:0000 0001 0726 5157); Lausanne University Hospital and University of Lausanne, Service of Pharmacy, Lausanne, Switzerland (GRID:grid.8515.9) (ISNI:0000 0001 0423 4662) 
Publication year
2021
Publication date
2021
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41598-021-92357-y
ProQuest document ID
2548900495
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.