During Early Pandemic, Pregnant Patients With COVID-19 Infection at Delivery Had Increased Risk of Death

A recent national-level analysis identified COVID-19 infection as a severe risk factor of adverse maternal outcomes, including morbidity and mortality, for pregnant women at delivery during the early part of the COVID-19 pandemic, which investigators published in JAMA Network Open. However, mortality decreased by from 232.9 to 79.1 per 100,000 deliveries over the entirety of the study period.

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“The evaluation of the initial pandemic period in this study demonstrates the substantial morbidity and mortality of COVID-19 in pregnant patients,” the study authors wrote in the paper.

There is growing awareness of the risk of COVID-19 infection on pregnant patients and adverse pregnancy outcomes. Data from research conducted both prior to and during the COVID-19 pandemic show the relationship between patient characteristics and pregnancy outcomes, according to the authors of the current study. Although there are limited national-level data comparing the risk of COVID-19 infection with pregnancy outcomes, it appears COVID-19 increases the risk of adverse pregnancy outcomes.

The aim of the current study was to evaluate the maternal outcomes associated with COVID-19 infection during the early pandemic period in the United States. The study included 2,578,095 hospital deliveries between April 2020 and December 2020. Individuals in the national patient estimates were 5.7% Asian, 14.7% Black, 20.6% Hispanic, and 50.7% White across more than 2691 centers.

The primary endpoints are patient characteristics associated with COVID-19 infection and severe maternal morbidity and mortality associated with COVID-19 at delivery (adjusting for known obstetric and delivery factors).

At delivery, 45,425 women were diagnosed with COVID-19. The following characteristics were associated with maternal COVID-19 infection:

• younger age
• later study period
• Black and Hispanic patients
• lower household income
• obesity
• medical comorbidity
• homelessness status
• residing in the US Northeast
• earlier gestational age
• admission to a larger urban hospital

Severe maternal morbidity was worse for patients with COVID-19 infection at delivery, possessing a greater risk of:

• tracheostomy
• ventilation
• acute myocardial infarction
• sepsis
• shock
• cardiac arrest
• coagulopathy
• respiratory distress syndrome

“The odds of severe respiratory complications were increased among pregnant patients with COVID-19 infection at delivery,” the investigators wrote.

In addition, the risk of mortality was 14 times greater among those who contracted COVID-19 at delivery. During the later period, the average time-to-death was 16 days among women who died during hospital admission. Time-to-death from April to June 2020 was 6 days, however, the fatality rate generally decreased from April to December 2020.

Study limitations included a lack of information on the severity and treatment of COVID-19 infection status. The study also did not specify neonatal outcomes, delivery indication, and cause of death either, requiring further research and evaluation.

“Increased failure-to-rescue risk following severe maternal morbidity among patients with COVID-19 adds important information,” the study authors wrote. “[The study] highlights the importance of prevention of COVID-19 in this population.”

Reference

Matsuo K, Green J, Herman S, et al. Severe Maternal Morbidity and Mortality of Pregnant Patients With COVID-19 Infection During the Early Pandemic Period in the US. Accessed April 10, 2023. JAMA Netw Open. 2023; doi:10.1001/jamanetworkopen.2023.7149