COVID-19 increases risk of pregnancy complications, study suggests

The study, which included nearly 2,400 pregnant women infected with SARS-CoV-2, found that those with moderate to severe infection were more likely to have a cesarean delivery, to deliver preterm, to die around the time of birth, or to experience serious illness from hypertensive disorders of pregnancy, postpartum hemorrhage, or from infection other than SARS-CoV-2. They were also more likely to lose the pregnancy or to have an infant die during the newborn period. Mild or asymptomatic infection was not associated with increased pregnancy risks.

“The findings underscore the need for women of child-bearing age and pregnant individuals to be vaccinated and to take other precautions against becoming infected with SARS-CoV-2,” said Diana Bianchi, M.D., director of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study. “This is the best way to protect pregnant women and their babies.”

The study was conducted by Torri D. Metz, M.D., of the University of Utah, Salt Lake City, and colleagues in the NICHD Maternal-Fetal Medicine Units Network. It appears in the Journal of the American Medical Association. Additional funding was provided by NIH’s National Center for Advancing Translational Sciences.

The study included more than 13,000 pregnant individuals from 17 U.S. hospitals, approximately 2,400 of whom were infected with SARS-CoV-2. Participants delivered between March 1 and December 31 2020, before SARS-CoV-2 vaccination was available. The researchers compared outcomes among those with COVID-19 to those from uninfected patients, and tabulated the study results as a primary outcome — whether the patient had died from any cause or had a serious illness or condition related to common obstetric complications. They also evaluated the results in terms of several secondary outcomes, including cesarean delivery, preterm birth, and fetal and newborn death.

Compared to uninfected patients, those with moderate to severe COVID-19 were more likely to experience the primary outcome, (26.1 vs 9.2%). They were also more likely to deliver by cesarean (45.4 vs 32.4%) or preterm (26.9 vs 14.1%) or to have a fetal or newborn death (3.5 vs 1.8%). Mild or asymptomatic COVID-19 was not associated with any of adverse outcomes.

Journal Reference:

1. Torri D. Metz, Rebecca G. Clifton, Brenna L. Hughes, Grecio J. Sandoval, William A. Grobman, George R. Saade, Tracy A. Manuck, Monica Longo, Amber Sowles, Kelly Clark, Hyagriv N. Simhan, Dwight J. Rouse, Hector Mendez-Figueroa, Cynthia Gyamfi-Bannerman, Jennifer L. Bailit, Maged M. Costantine, Harish M. Sehdev, Alan T. N. Tita, George A. Macones, Melissa Bickus, Francesca Facco, Janatha S. Grant, Amy M. Leath, Anna Bartholomew, Mark Landon, Kara Rood, Patrick Schneider, Heather Frey, Amanda L. Nelson, Sean Esplin, Michael W. Varner, Donna Allard, Janet Rousseau, Janet Milano, Lisa Early, Sabine Bousleiman, Ronald Wapner, Desmond Sutton, Haley Manchon, Ashley Salazar, Luis Pacheco, Shannon Clark, Hassan Harirah, Sangeeta Jain, Gayle Olson, Antonio Saad, Lindsey Allen, Guillermina Carrington, Jennifer Cornwell, Jennifer DeVolder, Wendy Dalton, Amanda Tyhulski, Ashley Mayle, Suneet P. Chauhan, Felecia Ortiz, John M. Thorp, Sally Timlin, Lena Fried, Hannah Byers, Jennifer Ferrara, Aimee Williams, Gail Mallett, Mercedes Ramos-Brinson, Samuel Parry, Meaghan McCabe, Christina Fazio, Anna Filipczak, Jennifer Craig, Lucia Muzzarelli, Abigail Roche, Elizabeth A. Thom (deceased), Crystal Nwachuku, V. Lynn Flowers-Fanomezantsoa, Monica Longo, Menachem Miodovnik, Stephanie W. Archer. Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications. JAMA, 2022; DOI: 10.1001/jama.2022.1190