Background To the best of our knowledge, no study has exhaustively evaluated the association between maternal morbidities and Coronavirus Disease 2019 (COVID-19) during the first wave of the pandemic in pregnant women. We investigated, in natural conceptions and assisted reproductive technique (ART) pregnancies, whether maternal morbidities were more frequent in pregnant women with COVID-19 diagnosis compared to pregnant women without COVID-19 diagnosis during the first wave of the COVID-19 pandemic. Methods and findings We conducted a retrospective analysis of prospectively collected data in a national cohort of all hospitalizations for births ≥22 weeks of gestation in France from January to June 2020 using the French national hospitalization database (PMSI). Pregnant women with COVID-19 were identified if they had been recorded in the database using the ICD-10 (International Classification of Disease) code for presence of a hospitalization for COVID-19. A total of 244,645 births were included, of which 874 (0.36%) in the COVID-19 group. Maternal morbidities and adverse obstetrical outcomes among those with or without COVID-19 were analyzed with a multivariable logistic regression model adjusted on patient characteristics. Among pregnant women, older age (31.1 (±5.9) years old versus 30.5 (±5.4) years old, respectively, p < 0.001), obesity (0.7% versus 0.3%, respectively, p < 0.001), multiple pregnancy (0.7% versus 0.4%, respectively, p < 0.001), and history of hypertension (0.9% versus 0.3%, respectively, p < 0.001) were more frequent with COVID-19 diagnosis. Active smoking (0.2% versus 0.4%, respectively, p < 0.001) and primiparity (0.3% versus 0.4%, respectively, p < 0.03) were less frequent with COVID-19 diagnosis. Frequency of ART conception was not different between those with and without COVID-19 diagnosis ( p = 0.28). When compared to the non-COVID-19 group, women in the COVID-19 group had a higher frequency of admission to ICU (5.9% versus 0.1%, p < 0.001), mortality (0.2% versus 0.005%, p < 0.001), preeclampsia/eclampsia (4.8% versus 2.2%, p < 0.001), gestational hypertension (2.3% versus 1.3%, p < 0.03), postpartum hemorrhage (10.0% versus 5.7%, p < 0.001), preterm birth at <37 weeks of gestation (16.7% versus 7.1%, p < 0.001), <32 weeks of gestation (2.2% versus 0.8%, p < 0.001), <28 weeks of gestation (2.4% versus 0.8%, p < 0.001), induced preterm birth (5.4% versus 1.4%, p < 0.001), spontaneous preterm birth (11.3% versus 5.7%, p < 0.001), fetal distress (33.0% versus 26.0%, p < 0.001), and cesarean section (33.0% versus 20.2%, p < 0.001). Rates of pregnancy terminations ≥22 weeks of gestation, stillbirths, gestational diabetes, placenta praevia, and placenta abruption were not significantly different between the COVID-19 and non-COVID-19 groups. The number of venous thromboembolic events was too low to perform statistical analysis. A limitation of this study relies in the possibility that asymptomatic infected women were not systematically detected. Conclusions We observed an increased frequency of pregnant women with maternal morbidities and diagnosis of COVID-19 compared to pregnant women without COVID-19. It appears essential to be aware of this, notably in populations at known risk of developing a more severe form of infection or obstetrical morbidities and in order for obstetrical units to better inform pregnant women and provide the best care. Although causality cannot be determined from these associations, these results may be in line with recent recommendations in favor of vaccination for pregnant women. In a national retrospective study, Sylvie Epelboin and colleagues investigate obstetrical outcomes and maternal morbidities among pregnant women with a COVID-19 diagnosis in France. Author summary Why was this study done? In early 2020, as infection by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spread worldwide, it was not known whether pregnant women with Coronavirus Disease 2019 (COVID-19) were at greater risk for maternal morbidities and adverse obstetric outcomes. We sought to evaluate in what extent the risk of maternal morbidities and obstetrical adverse outcomes and COVID-19 diagnosis in pregnant women could be associated. The possibility of having access to obstetric data of all pregnant women hospitalized in France around childbirth during the first wave of COVID-19, from January to June 2020, through access to data from the National Health Data System, allowed us to obtain results on a large representative national cohort. What did the researchers do and find? We conducted a retrospective analysis of a national cohort of all hospitalizations for birth ≥22 weeks of gestation occurring in France from January to June 2020, using the French national hospitalization database (PMSI). Maternal morbidities and adverse obstetrical outcomes with or without COVID-19 were analyzed with a model adjusted on patient characteristics that could be risk factors: maternal age, body mass index, active smoking, parity, history of diabetes or hypertension, multiple pregnancy, and assisted reproductive technique (ART) conception. Pregnant women with COVID-19 diagnosis were more likely to be older, have obesity, a multiple pregnancy, and history of hypertension, compared to those without COVID-19. Active smoking and primiparity were less frequent among those with COVID-19 and rates of conception using ART were similar between the 2 groups. When compared to the non-COVID-19 group, women in the COVID-19 group had a higher frequency of admission to intensive care unit, mortality, preeclampsia/eclampsia, gestational hypertension, peripartum and postpartum hemorrhage, preterm and very preterm spontaneous and induced birth, and cesarean section. Rates of pregnancy terminations, stillbirths, gestational diabetes, placenta praevia, placenta abruption, and venous thromboembolic events were not increased. What do these findings mean? These findings suggest that pregnant women with COVID-19 disease may have an increased risk of obstetrical morbidities when compared to non-COVID-19 pregnant controls. Results of this study may inform prevention and treatment policies for pregnant women with COVID-19. In clinical practice, it appears essential to be aware of these complications, notably in populations at known risk of developing a more severe form of infection or obstetrical morbidities and in order for obstetrical units to better inform pregnant women and provide the best care. Although causality cannot be established from our study, these findings raise the possibility that vaccination, which can be offered to pregnant women starting from the second trimester according to recommendations of several health authorities, may be useful to protect women from obstetrical excess risk, in particular in high-risk populations.
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