Clinical characteristics of pregnant women infected with Coronavirus Disease 2019 in China: a nationwide case-control study

Abstract

OBJECTIVE

To formally compare the clinical course of Coronavirus disease 2019 (COVID-19) in pregnant women with their nonpregnant counterparts.

METHODS

Clinical data of pregnant women with confirmed COVID-19 in the designated hospitals of mainland China were retrieved up to April 12, 2020 through an epidemic reporting system maintained at the National Health Commission of the People’s Republic China. Each pregnant patient was randomly matched to a nonpregnant woman with confirmed COVID-19 in the same hospital as control, then their clinical courses were formally compared.

RESULTS

138 pregnant women had been identified as confirmed COVID-19 cases. Among them, 17 severe cases and 1 maternal death were recorded, which was less than their nonpregnant peers (23 severe cases and 3 death). 57.2% had been infected with SARS-CoV-2 during the third trimester, including 13 severe cases and 1 maternal death. 7.3% of pregnant patients had diarrhea and 3.6% had nausea or vomiting, compared with related proportion as 15.2% (OR: 0.38, 95%CI: 0.15, 0.96) and 10.1% (OR: 0.25, 95%CI: 0.07, 0.89) in nonpregnant patients. Pregnant patients infected with SARS-CoV-2 in early pregnancy presented similar laboratory tests with their nonpregnant peers, however, with pregnancy progresses, increased inflammation, coagulation and hepatic injury markers happened more and more frequently ( p <0.001) in pregnant patients.

CONCLUSIONS

Being pregnant did not represent a risk for severe condition when compared with their nonpregnant peers. Patients infected with SARS-CoV-2 in early pregnancy were even at lower risk of severe illness than those infected in late pregnancy.

What are the novel findings of this work?

Compared with non-pregnant COVID-19 patients, pregnant patients tend to present less symptom, had unique laboratory findings, and tend to at lower risk of COVID-19–related death. Patients infected with SARS-CoV-2 in the early pregnancy tend to be in the less severe condition of illness than those infected in late pregnancy.

What are the clinical implications of this work?

Vital comparisons of the clinical course upon COVID-19 between pregnant and nonpregnant women in childbearing age are, unfortunately, lacking. Through formally comparisons between the two groups, the present study provides more reliable evidence towards the management of pregnant women with COVID-19.

SciScore for 10.1101/2021.10.21.21265313: (What is this?)

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

Table 1: Rigor

Ethics	IRB: The study was approved in accordance with the agreed procedure with the Ethics Committee of Peking University Third Hospital, waiving written informed consent for deidentified patient data. Consent: The study was approved in accordance with the agreed procedure with the Ethics Committee of Peking University Third Hospital, waiving written informed consent for deidentified patient data.
Sex as a biological variable	Thus, ‘cases’ were defined as pregnant COVID-19 patients.
Randomization	6 Each pregnant patient was matched to a confirmed patient who was non pregnant, with same age and admitted in same hospital as ‘control’ by simple randomization.
Blinding	not detected.
Power Analysis	not detected.

Table 2: Resources

No key resources detected.

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:

It is also worth noting that the findings of the present study are subject to limitation of missing data. We can hardly rule out the existence of missed case due to the pregnant COVID-19 cases were identified based on the uploaded medical records. However, we undertook a meticulous process in reviewing previous literatures and then believed that the present study had the capability to capture a national picture of the impact of COVID-19 on pregnancy. Additionally, given the variation in the clinical process of diagnosis and treatment and the electronic medical records databases among the designated hospitals, some cases had missing values in the laboratory testing. It may lead to misestimation of some characteristics if those with missing data were systematically different from those with available data. Further, collection and comparation of longitudinal data for pregnant women with and without SARS-CoV-2 infection during the outbreak is needed to understand the effects of SARS-CoV-2 infection on maternal and neonatal outcomes. In summary, compared with nonpregnant COVID-19 patients, being pregnant did not represent a risk for severe condition. Moreover, patients infected with SARS-CoV-2 in early pregnancy were at lower risk of severe illness than those infected in late pregnancy.

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.

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