Pregnancy and postpartum outcomes in a universally tested population for SARS-CoV-2 in New York City: A prospective cohort study

Malavika Prabhu, Kristen Cagino, Kathy C Matthews, Rachel L Friedlander, Shannon M Glynn, Jeffrey M Kubiak, Yawei J Yang, Zhen Zhao, Rebecca N Baergen, Jennifer I DiPace, Armin S Razavi, Daniel W Skupski, Jon R Snyder, Harjot K Singh, Robin B Kalish, Corrina M Oxford, Laura E Riley
BJOG: An International Journal of Obstetrics and Gynaecology 2020 July 7

OBJECTIVE: To describe differences in outcomes between pregnant women with and without COVID-19 DESIGN: Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for SARS-CoV-2 using reverse transcriptase polymerase chain reaction (RT-PCR). All infants of mothers with COVID-19 underwent SARS-CoV-2 testing.

SETTING: Three New York City hospitals POPULATION: Pregnant women > 20 weeks' gestation admitted for delivery METHODS: Data were stratified by SARS-CoV-2 result and symptomatic status, and summarized using parametric and nonparametric tests.

MAIN OUTCOME MEASURES: Prevalence and outcomes of maternal COVID-19; obstetric outcomes; neonatal SARS-CoV-2; placental pathology.

RESULTS: Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities between women with symptomatic vs. asymptomatic vs. no COVID-19. Cesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19, and 30.9% without COVID-19 (p=0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 vs 4.5% of women without COVID-19 (p<0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with vs. without COVID-19 (48.3% vs 11.3%, p <0.001).

CONCLUSION: Among pregnant women with COVID-19 at delivery, we observed increased cesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 infections remote from delivery.

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