Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019.
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D'Antonio Francesco, Sen Cihat, Mascio Daniele Di, Galindo Alberto, Villalain Cecilia, Herraiz Ignacio, Arisoy Resul, Ovayolu Ali, Eroğlu Hasan, Canales Manuel Guerra, Ladella Subhashini, Cojocaru Liviu, Turan Ozhan, Turan Sifa, Hadar Eran, Brzezinski-Sinai Noa A, Dollinger Sarah, Uyaniklar Ozlem, Ocakouglu Sakine Rahimli, Atak Zeliha, Premru-Srsen Tanja, Kornhauser-Cerar Lilijana, Druškovič Mirjam, Ples Liana, Gündüz Reyhan, Ağaçayak Elif, Schvartzman Javier Alfonso, Malbran Mercedes Negri, Liberati Marco, Sebastiano Francesca Di, Oronzi Ludovica, Cerra Chiara, Buca Danilo, Cagnacci Angelo, Ramone Arianna, Barra Fabio, Carosso Andrea, Benedetto Chiara, Cosma Stefano, Pintiaux Axelle, Daelemans Caroline, Costa Elena, Özel Ayşegül, Muhçu Murat, Lopez Jesús S Jimenez, Alvarado Clara, Piqueras Anna Luengo, Oliva Dolores Esteban, Schera Giovanni Battista Luca, Volpe Nicola, Frusca Tiziana, Samardjiski Igor, Simeonova Slagjana, Papestiev Irena Aleksioska, Hojman Javier, Turkcuoglu Ilgin, Cromi Antonella, Laganà Antonio Simone, Ghezzi Fabio, Sirico Angelo, Familiari Alessandra, Scambia Giovanni, Sukhikh Zulfiya Khodjaeva Gennady T, Gorina Ksenia A, de Sa Renato Augusto Moreira, Vaz Mariana, Feuerschuette Otto Henrique May, Gatta Anna Nunzia Della, Youssef Aly, Donna Gaetana Di, Martinez-Varea Alicia, Loscalzo Gabriela, Morales Roselló José, Stefanovic Vedran, Nupponen Irmeli, Nelskylä Kaisa, Ayala Rodrigo, Molpeceres Rebeca Garrote, Vázquez Asunción Pino, Sandri Fabrizio, Cataneo Ilaria, Lenzi Marinella, Haberal Esra Tustas, Huertas Erasmo, Sanchez Amadeo, Arango Pedro, Bermejo Amanda, Alcantara María Monica Gonzalez, Göynümer Gökhan, Okuyan Erhan, Madalina Ciuhodaru, Guisan Ana Concheiro, Schulte Alejandra Martínez, Esposito Valentina, De Robertis Valentina, Zdjelar Snezana, Lackovic Milan, Mihajlovic Sladjana, Jekova Nelly, Saccone Gabriele, Aslan Mehmet Musa, Dedda Maria Carmela Di, Chalid Maisuri, Canache Jose Enrique Moros, Daskalakis George, Antsaklis Panos, Vega Enrique Criado, Cueto Elisa, Taccaliti Chiara, Aykanat Yeliz, Özlem Genç Şerife, Froessler Bernd, Radulova Petya Angelova, Morano Danila, Bianchi Beatrice, Marino Maria Giulia Lombana, Meccariello Gabriella, Rohatgi Bindu, Schiattarella Antonio, Morlando Maddalena, Colacurci Nicola, Villasco Andrea, Biglia Nicoletta, Marques Ana Luiza Santos, Gatti Alessandra, Luvero Daniela, Angioli Roberto, Pittaro Alejandro, Lila Albert, Zlatohlávková Blanka, On the behalf of the World Association of Perinatal Medicine working group on coronavirus disease 2019
Аннотация
OBJECTIVE: This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.
STUDY DESIGN: This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data.
RESULTS: A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes.
CONCLUSION: High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.