COVID-19 outcomes in hospitalized puerperal, pregnant, and neither pregnant nor puerperal women

  1. Fabiano Elisei Serra
  2. Rossana Pulcineli Vieira Francisco
  3. Patricia de Rossi
  4. Maria de Lourdes Brizot
  5. Agatha Sacramento Rodrigues

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

To compare hospitalized reproductive age women with COVID-19 who were pregnant, puerperal, or neither one nor the other in terms of demographic and clinical characteristics and disease progression using Brazilian epidemiological data.

Methods

A retrospective analysis of the records of the Information System of the Epidemiological Surveillance of Influenza of the Health Ministry of Brazil was performed. It included the data of female patients aged 10 to 49 years hospitalized because of severe COVID-19 disease (RT-PCR+ for SARS-CoV-2), from February 17, 2020 to January 02, 2021. They were separated into 3 groups: pregnant, puerperal, and neither pregnant nor puerperal. General comparisons and then adjustments for confounding variables (propensity score matching [PSM]) were made, using demographic and clinical characteristics, disease progression (admission to the intensive care unit [ICU] and invasive or noninvasive ventilatory support), and outcome (cure or death). Deaths were analyzed in each group according to comorbidities, invasive or noninvasive ventilatory support, and admission to the ICU.

Results

As many as 40,640 reproductive age women hospitalized for COVID-19 were identified: 3,372 were pregnant, 794 were puerperal, and 36,474 were neither pregnant nor puerperal. Groups were significantly different in terms of demographic data and comorbidities (p<0.0001). Pregnant and puerperal women were less likely to be symptomatic than the women who were neither one nor the other (72.1%, 69.7% and 88.8%, respectively). Pregnant women, however, had a higher frequency of anosmia, and ageusia than the others. After PSM, puerperal women had a worse prognosis than pregnant women with respect to admission to the ICU, invasive ventilatory support, and death, with OR (95% CI) 1.97 (1.55 – 2.50), 2.71 (1.78 – 4.13), and 2.51 (1.79 – 3.52), respectively.

Conclusion

Puerperal women were at a higher risk for serious outcomes (need for the ICU, need for invasive and noninvasive ventilatory support, and death) than pregnant women.

Article activity feed

  1. Version published to 10.1371/journal.pone.0259911
  2. ScreenIT

    SciScore for 10.1101/2021.07.27.21261163: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: Therefore, according to Brazilian Ethics regulatory requirements, there is no need for ethical approval by an Institutional Review Board.
    Sex as a biological variableSearch included all data on female patients aged 10 to 49 years hospitalized with COVID-19, confirmed with a positive RT-PCR result for SARS-CoV-2.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    As study limitations, a comparison with those infected with COVID-19 in the general population could not be made because only hospitalized cases with SARS and deaths are notified, and bias introduced by missing variables cannot be eliminated. In the present study, the death risk of each comorbidity was identified separately for the three groups of women: pregnant, puerperal, and neither pregnant nor puerperal. This enabled the use of ORs included in the risk calculations for the COVID-19 progression at hospital admission. Since puerperal women were at a higher risk for the most severe outcomes (need for ICU, use of invasive ventilatory support, and death), the fact that pregnancy is over must not underestimate the severity risks. Thus, in those cases in which the SARS-CoV-2 infection is acquired at the end of pregnancy, the delivery should be considered only after overcoming the disease. When it is acquired during the puerperal period, health professionals should remain alert to the severity-related risks.It would be ideal if all women were vaccinated to minimize the risks of SARS-CoV-2 infection and if they adhered to protection measures to prevent contamination by the virus. As puerperal turned out to be a higher risk group than pregnant women among those hospitalized due to COVID-19, we need more studies comparing these groups. Furthermore, it should be considered that childbirth might influence the progression of COVID-19.

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.07.27.21261163v1 on medRxiv