Summary and introduction
Preface
Pregnant women may be at increased risk of severe coronavirus disease (COVID-19) in 2019. This may be related to changes in the immune system and respiratory physiology *.[1] In addition, the consequences of adverse births such as preterm birth and stillbirth may be more common among pregnant women infected with SARS-CoV-2, the virus that causes COVID-19.[2,3] Information on SARS-CoV-2 infection during pregnancy is growing rapidly. However, data on reasons for hospitalization, pregnancy-specific characteristics, and childbirth outcomes for pregnant women hospitalized for SARS-CoV-2 infection are limited. From March 1st to May 30th, 2020, as part of the Vaccine Safety Data Link (VSD)†Monitoring of COVID-19 hospitalization, 105 hospitalized pregnant women with SARS-CoV-2 infection were identified. Of these, 62 (59%) were hospitalized for obstetrical reasons (ie, delivery and childbirth or other pregnancy-related indications) and 43 (41%) were hospitalized for COVID-19 disease without obstetrical reasons. Overall, 50 (81%) of 62 pregnant women with SARS-CoV-2 infection who were hospitalized for obstetrical reasons were asymptomatic. Of the 43 pregnant women hospitalized with COVID-19, 13 (30%) were admitted to the intensive care unit (ICU), 6 (14%) needed a ventilator, and 1 was COVID-19. Died in. Obesity during pregnancy was more common among pregnant women hospitalized with COVID-19 (44%) than among asymptomatic pregnant women hospitalized for obstetric reasons (31%). Similarly, the proportion of pregnant women admitted with COVID-19 for gestational diabetes (26%) was higher than the proportion of women admitted for obstetric reasons (8%). Preterm birth occurred in 15% of the pregnancies of 93 women who gave birth, and stillbirth (fetal death above 20 weeks gestation) occurred in 3%. Prenatal counseling that emphasizes precautionary measures (eg, mask use, frequent hand washing, social distance) may help prevent COVID-19 in pregnant women.§ People with pre-pregnancy obesity and gestational diabetes may reduce the negative effects of pregnancy.
VSD is a collaboration between the CDC Vaccination Safety Office and nine medical institutions in the United States, serving more than 12 million people each year. Hospitalization with COVID-19 patient diagnosis was identified using COVID-19 International Classification of Diseases, 10th revision, Clinical correction, (ICD-10-CM)¶ Site-specific internal diagnostic code from March 1st to May 30th, 2020. Pregnant women were identified using a validated algorithm based on the ICD-9 diagnosis and procedure code.[4] This has been modified for ICD-10. In this study, medical records of women admitted with COVID-19 were reviewed by the abstractor and ruled by a physician, the main reasons for admission of women who gave birth before July 31, pregnancy characteristics, COVID- 19 complications and childbirth outcomes have been identified. 2020.
Pregnant women diagnosed with COVID-19 were divided into three groups based on the main reasons for hospitalization: 1) Treatment of COVID-19 for no obstetric reason (eg, exacerbation of dyspnea). 2) Obstetric reasons with symptoms consistent with COVID-19 (eg fever, chills, cough, shortness of breath). 3) There is no symptom compatible with COVID-19 (or there is a history of COVID-19 resolution), but the SARS-CoV-2 test result is positive at admission. The demographic and pregnancy characteristics of pregnant women admitted with COVID-19 were compared to those of women admitted for obstetric reasons. Birth results for pregnant women infected with SARS-COV-2 were compared to the background rates of all pregnant women at eight VSD sites during the study period. This activity was reviewed by the CDC and carried out in accordance with applicable federal law and CDC policy. ** All analyzes were performed using SAS software (version 9.4; SAS Institute).
Between March 1st and May 30th, 105 (2.4%) pregnant women were identified out of 4,408 who were admitted to the VSD site with a COVID-19 diagnosis. The SARS-CoV-2 real-time reverse transcription-polymerase chain reaction test was positive in 104 women. Another woman who tested negative for SARS-CoV-2 was symptomatic and was in close contact with confirmed COVID-19. She had a clinical diagnosis of COVID-19. Of these 105 pregnant women, 43 (41.0%) were hospitalized for COVID-19 disease and 62 (59.0%) were hospitalized for obstetric reasons (59.0%).table 1). Of the 62 women hospitalized for obstetric reasons, 12 (19.4%) showed symptoms compatible with COVID-19 and 50 (80.6%) were asymptomatic. The median age of all women is 30 years (range = 17-54 years), with 61.9% Hispanic or Latin (range)Table 2). 14 (13.3%) pregnant women were required to enter the ICU, including 13 (30.2%) of the 43 women hospitalized for COVID-19. Six of these women needed mechanical ventilation, one was hospitalized at 15 weeks gestation and died of COVID-19. Prevalence of obesity during pregnancy (body mass index ≥ 30 kg / m)2) Was 36.2% overall, with 43 women (44.2%) hospitalized for COVID-19 higher than 62 women (30.6%) hospitalized for obstetric reasons. Similarly, the prevalence of gestational diabetes was higher in women hospitalized with COVID-19 (25.6%) than in women hospitalized for obstetric reasons (8.1%).
Of all 105 pregnant women hospitalized with COVID-19, 93 (88.6%) had a pregnancy outcome by 31 July (3).Table 3), Includes 79 (84.9%) who gave birth during the first hospitalization and 14 (15.1%) who gave birth during the subsequent hospitalization. One of the remaining 12 women died during the first hospitalization and 11 were still pregnant at the time of analysis. The prevalence of preterm birth was 15.1% overall and 12.2% at birth, about 70% higher than the baseline rate of VSD during the study period (8.9% at 43,571 births and stillbirths). The prevalence of stillbirth (3.2%) was more than four-fold higher than the baseline rate of VSD (0.6%) during the study period among women with SARS-CoV-2. All three stillbirths were prepartum. One was accompanied by placental abruption, and two were ruling-based and unidentified.
