TY  - JOUR
TI  - Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection
AU  - José Villar
AU  - Shabina Ariff
AU  - Robert B. Gunier
AU  - Ramachandran Thiruvengadam
AU  - Stephen Rauch
AU  - Kholin A.M. Kholin
AU  - Paola Roggero
AU  - Federico Prefumo
AU  - Marynéa Silva do Vale
AU  - Jorge Arturo Cardona–Pérez
AU  - Nerea Maíz
AU  - Irene Cetin
AU  - Valeria Savasi
AU  - Philippe Deruelle
AU  - Sarah Rae Easter
AU  - Joanna Sichitiu
AU  - Constanza P. Soto Conti
AU  - Ernawati Ernawati
AU  - Mohak Mhatre
AU  - Jagjit S. Teji
AU  - Becky Liu
AU  - Carola Capelli
AU  - M. Oberto
AU  - Laura Salazar
AU  - Michael G. Gravett
AU  - Paolo Ivo Cavoretto
AU  - Vincent Bizor Nachinab
AU  - Hadiza Galadanci
AU  - D. Orós
AU  - Adejumoke Idowu Ayede
AU  - Loı̈c Sentilhes
AU  - Babagana Bako
AU  - Mónica Savorani
AU  - Hellas Cena
AU  - Perla K. García-May
AU  - Saturday Etuk
AU  - Roberto Casale
AU  - Sherief Abd‐Elsalam
AU  - Satoru Ikenoue
AU  - Muhammad Baffah Aminu
AU  - Carmen Vecciarelli
AU  - Eduardo Alfredo Duro
AU  - Mustapha Ado Usman
AU  - Yetunde O. John-Akinola
AU  - Ricardo Nieto
AU  - E. Ferrazzi
AU  - Zulfiqar A Bhutta
AU  - Ana Langer
AU  - Stephen Kennedy
AU  - Aris T. Papageorghiou
PY  - 2021
JO  - Archives of Pediatrics and Adolescent Medicine
DO  - 10.1001/jamapediatrics.2021.1050
UR  - https://doi.org/10.1001/jamapediatrics.2021.1050
AB  - Importance: Detailed information about the association of COVID-19 with outcomes in pregnant individuals compared with not-infected pregnant individuals is much needed. Objective: To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals. Design, Setting, and Participants: In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. Exposures: COVID-19 in pregnancy determined by laboratory confirmation of COVID-19 and/or radiological pulmonary findings or 2 or more predefined COVID-19 symptoms. Main Outcomes and Measures: The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity. Results: A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years). Overweight early in pregnancy occurred in 323 women (48.6%) with COVID-19 diagnosis and 554 women (40.2%) without. Women with COVID-19 diagnosis were at higher risk for preeclampsia/eclampsia (relative risk [RR], 1.76; 95% CI, 1.27-2.43), severe infections (RR, 3.38; 95% CI, 1.63-7.01), intensive care unit admission (RR, 5.04; 95% CI, 3.13-8.10), maternal mortality (RR, 22.3; 95% CI, 2.88-172), preterm birth (RR, 1.59; 95% CI, 1.30-1.94), medically indicated preterm birth (RR, 1.97; 95% CI, 1.56-2.51), severe neonatal morbidity index (RR, 2.66; 95% CI, 1.69-4.18), and severe perinatal morbidity and mortality index (RR, 2.14; 95% CI, 1.66-2.75). Fever and shortness of breath for any duration was associated with increased risk of severe maternal complications (RR, 2.56; 95% CI, 1.92-3.40) and neonatal complications (RR, 4.97; 95% CI, 2.11-11.69). Asymptomatic women with COVID-19 diagnosis remained at higher 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 polymerase chain reaction), 54 (13%) of their neonates 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 increased risk for 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 and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.
ER  -