Increased risk of severe COVID-19 in pregnancy in a multicenter propensity score-matched study

  1. Liviu Cojocaru
  2. Myint Noe
  3. Autusa Pahlavan
  4. Alissa Werzen
  5. Hyunuk Seung
  6. Young Chae Jessica Yoo
  7. Patricia Tyson
  8. Shivakumar Narayanan
  9. Shifa Turan
  10. Ozhan M. Turan
  11. Joel V. Chua

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Abstract

Objectives

To explore the association between COVID-19 severity and pregnancy using measures such as COVID-19 ordinal scale severity score, hospitalization, intensive care unit (ICU) admission, oxygen supplementation, invasive mechanical ventilation, and death.

Methods

We conducted a retrospective, multicenter cohort study to understand the association between COVID-19 severity and pregnancy. We reviewed consecutive charts of adult females, ages 18–45, with laboratory testing for SARS-CoV-2 infection between March 1, 2020, and August 31, 2020. Cases were patients diagnosed with COVID-19 during pregnancy, whereas controls were not pregnant at the time of COVID-19 diagnosis. Primary endpoints were the COVID-19 severity score at presentation (within four hours) and the nadir of the clinical course. The secondary endpoints were the proportion of patients requiring hospitalization, ICU admission, oxygen supplementation, invasive mechanical ventilation, and death.

Results

A higher proportion of pregnant women had moderate to severe COVID-19 disease at the nadir of the clinical course than non-pregnant women (25 vs. 16.1 %, p=0.04, respectively). There was a higher rate of hospitalization (25.6 vs. 17.2 %), ICU admission (8.9 vs. 4.4 %), need for vasoactive substances (5.0 vs. 2.8 %), and invasive mechanical ventilation (5.6 vs. 2.8 %) in the pregnant cohort. These differences were not significant after applying propensity score matching.We found a high rate of pregnancy complications in our population (40.7 %). The most worrisome is the rate of hypertensive disorders of pregnancy (20.1 %).

Conclusions

In our propensity score-matched study, COVID-19 in pregnancy is associated with an increased risk of disease severity and pregnancy complications.

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  1. Version published to 10.1515/jpm-2023-0068
  2. ScreenIT

    SciScore for 10.1101/2021.06.18.21258899: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The Institutional Review Board at the University of Maryland, Baltimore, approved the study under the protocol HP-00093213.
    Sex as a biological variableWe reviewed consecutive charts of adult females, ages 18-45, who had laboratory-confirmed SARS-CoV-2 infection in six months between March 1, 2020, and August 31, 2020.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data were collected and entered into a secure database, Research Electronic Data Capture (REDCap) software16, 17, hosted at the University of Maryland, Baltimore.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)
    Analyses were performed with SAS software version 9.4 (SAS Institute, Cary, NC).
    SAS
    suggested: (SASqPCR, RRID:SCR_003056)
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: To our knowledge, this is the first study to evaluated pregnancy impact on COVID-19 severity using a PSM control. Our study’s strengths are a relatively large sample size for both pregnant and nonpregnant groups and a well-matched propensity score population, which decreases the impact of confounding factors. Lastly, our population is predominantly Hispanic and non-Hispanic Black, which has been disproportionately affected by COVID-196 and contributes to understanding risk factors and outcomes in this population. The limitations of our study are mainly related to the retrospective design. A certain proportion of patients were excluded by design from the data analysis for PSM. Since these patients would have belonged to the nonpregnant control group, this exclusion is unlikely to have influenced the PSM results. There might have been differential testing practices or test availability between pregnant and nonpregnant populations or disadvantaged groups. Even though we excluded non-COVID-19 related hospitalizations, the threshold for hospitalization might have been lower in the pregnant group. Likewise, the pregnancy goal for oxygen saturation of greater than 94% might have resulted in lower thresholds for oxygen supplementation. Lastly, the study is likely underpowered to detect a difference in rare events such as the need for renal replacement therapy, extracorporeal membrane oxygenation, and death. In addition, while we controlled for the most comm...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.06.18.21258899v1 on medRxiv