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Severe Maternal Morbidity, Mortality Up With COVID-19 in Pregnancy

FRIDAY, April 23, 2021 -- COVID-19 in pregnancy is associated with increased severe maternal morbidity and mortality, according to a study published online April 22 in JAMA Pediatrics.

José Villar, M.D., from the University of Oxford in the United Kingdom, and colleagues examined the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared to noninfected pregnant individuals in a cohort study involving 43 institutions in 18 countries. Data were included for 706 pregnant women with a COVID-19 diagnosis and 1,424 pregnant women without a COVID-19 diagnosis, with broadly similar demographic characteristics.

The researchers found that 48.6 percent of women with a COVID-19 diagnosis and 40.2 percent without had overweight early in pregnancy. Increased risks for preeclampsia/eclampsia, severe infections, intensive care unit admission, maternal mortality, preterm birth, medically indicated preterm birth, severe neonatal morbidity index, and severe perinatal morbidity and mortality index were seen for women with a COVID-19 diagnosis (relative risks [RRs], 1.76, 3.38, 5.04, 22.3, 1.59, 1.97, 2.66, and 2.14, respectively). There was a correlation noted for fever and shortness of breath of any duration with an increased risk of severe maternal complications and neonatal complications (RRs, 2.56 and 4.97, respectively). Only risks for maternal morbidity and preeclampsia remained increased for asymptomatic women with a COVID-19 diagnosis (RRs, 1.24 and 1.63, respectively). Thirteen percent of the neonates of women who tested positive also tested positive. The risk for neonatal test positivity was increased for cesarean delivery but not breastfeeding.

"We demonstrated that women with COVID-19 diagnosis, compared with those without COVID-19 diagnosis, were at substantially increased risk of severe pregnancy complications," the authors write.

One author disclosed financial ties to Ferring Pharmaceutical and Bayer; a second author disclosed ties to Intelligent Ultrasound.

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