Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection: The INTERCOVID Multinational Cohort Study

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ABSTRACT

Importance: Detailed information on the association of COVID-19 and its final outcome in pregnant women compared to uninfected pregnant women is necessary.

Objective: To assess the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared to uninfected pregnant women.

Design, environment and participants: In this cohort study conducted from March to October 2020, involving 43 institutions from 18 countries, uninfected women were enrolled simultaneously, immediately after infected women were identified, at any stage of pregnancy or delivery, and with the same level of care to minimize bias. Women and newborns were followed until hospital discharge.

Exhibitions: COVID-19 in pregnancy was determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms.

Objectives and main results: The primary endpoint measures were morbidity and mortality rates (maternal and severe neonatal/perinatal). The individual components of these indices were secondary objectives. Models for these outcomes were adjusted for country, month of study entry, maternal age, and morbidity history.

Results: A total of 706 pregnant women with a diagnosis of COVID-19 and 1.424 pregnant women without a diagnosis of COVID-19 were enrolled, all with very similar demographic characteristics (mean [SD] age, 30,2 [6,1] years). Overweight at the beginning of pregnancy occurred in 323 women (48,6%) with a diagnosis of COVID-19 and in 554 women (40,2%) without it.

Women diagnosed with COVID-19 had a higher risk of:

• Preeclampsia/eclampsia (relative risk [RR], 1,76; 95% CI, 1,27-2,43)
• Serious infections (RR, 3,38; 95% CI, 1,63-7,01)
• Admissions to the Intensive Care Unit (RR, 5.04; 95% CI, 3.13-8.10)
• Maternal mortality (RR, 22.3; 95% CI, 2.88-172)
• Premature birth (RR, 1.59; 95% CI, 1.30-1.94),
• Premature birth due to medical indication (RR, 1,97; 95% CI, 1,56-2,51)
• Severe neonatal morbidity rate (RR, 2,66; 95% CI, 1,69-4,18)
• Severe perinatal morbidity and mortality rate (RR, 2,14; 95% CI, 1,66-2,75)

Fever and dyspnea for any duration were associated with an increased risk of serious maternal complications (RR, 2,56; 95% CI, 1,92-3,40) and neonatal complications (RR, 4,97; 95% CI, 2,11-11,69). XNUMX%, XNUMX-XNUMX).

Asymptomatic women diagnosed with COVID-19 remained at increased risk only for maternal morbidity (RR, 1,24; 95% CI, 1,00-1,54) and preeclampsia (RR, 1,63; 95% CI , 1,01-2,63).

Among women who tested positive (98,1% by real-time PCR), 54 (13%) of their newborns tested positive. Cesarean delivery (RR, 2,15; 95% CI, 1,18-3,91) but not breastfeeding (RR, 1,10; 95% CI, 0,66-1,85) was associated with a higher risk of neonatal test positivity.

Conclusions and relevance: In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity, mortality, and neonatal complications when comparing pregnant women with and without a diagnosis of COVID-19. The findings should serve as an alert to pregnant women and doctors to strictly implement all recommended COVID-19 preventive measures.