TY - JOUR
T1 - Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period
T2 - a sequential, prospective meta-analysis
AU - Smith, Emily R.
AU - Oakley, Erin
AU - Grandner, Gargi Wable
AU - Rukundo, Gordon
AU - Farooq, Fouzia
AU - Ferguson, Kacey
AU - Baumann, Sasha
AU - Adams Waldorf, Kristina Maria
AU - Afshar, Yalda
AU - Ahlberg, Mia
AU - Ahmadzia, Homa
AU - Akelo, Victor
AU - Aldrovandi, Grace
AU - Bevilacqua, Elisa
AU - Bracero, Nabal
AU - Brandt, Justin S.
AU - Broutet, Natalie
AU - Carrillo, Jorge
AU - Conry, Jeanne
AU - Cosmi, Erich
AU - Crispi, Fatima
AU - Crovetto, Francesca
AU - del Mar Gil, Maria
AU - Delgado-López, Camille
AU - Divakar, Hema
AU - Driscoll, Amanda J.
AU - Favre, Guillaume
AU - Fernandez Buhigas, Irene
AU - Flaherman, Valerie
AU - Gale, Christopher
AU - Godwin, Christine L.
AU - Gottlieb, Sami
AU - Gratacós, Eduard
AU - He, Siran
AU - Hernandez, Olivia
AU - Jones, Stephanie
AU - Joshi, Sheetal
AU - Kalafat, Erkan
AU - Khagayi, Sammy
AU - Knight, Marian
AU - Kotloff, Karen L.
AU - Lanzone, Antonio
AU - Laurita Longo, Valentina
AU - Le Doare, Kirsty
AU - Lees, Christoph
AU - Litman, Ethan
AU - Lokken, Erica M.
AU - Madhi, Shabir A.
AU - Magee, Laura A.
AU - Martinez-Portilla, Raigam Jafet
AU - Metz, Torri D.
AU - Miller, Emily S.
AU - Money, Deborah
AU - Moungmaithong, Sakita
AU - Mullins, Edward
AU - Nachega, Jean B.
AU - Nunes, Marta C.
AU - Onyango, Dickens
AU - Panchaud, Alice
AU - Poon, Liona C.
AU - Raiten, Daniel
AU - Regan, Lesley
AU - Sahota, Daljit
AU - Sakowicz, Allie
AU - Sanin-Blair, Jose
AU - Stephansson, Olof
AU - Temmerman, Marleen
AU - Thorson, Anna
AU - Thwin, Soe Soe
AU - Tippett Barr, Beth A.
AU - Tolosa, Jorge E.
AU - Tug, Niyazi
AU - Valencia-Prado, Miguel
AU - Visentin, Silvia
AU - von Dadelszen, Peter
AU - Whitehead, Clare
AU - Wood, Mollie
AU - Yang, Huixia
AU - Zavala, Rebecca
AU - Tielsch, James M.
N1 - Publisher Copyright:
© 2022
PY - 2023/2
Y1 - 2023/2
N2 - Objective: This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. Data Sources: We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. Study Eligibility Criteria: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. Methods: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis. Results: We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12–2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27–13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87–22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83–70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26–2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20–3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28–2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18–2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25–2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15–4.81). Conclusion: We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19–related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.
AB - Objective: This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. Data Sources: We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. Study Eligibility Criteria: Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. Methods: We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis. Results: We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12–2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27–13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87–22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83–70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26–2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20–3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28–2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18–2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25–2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15–4.81). Conclusion: We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19–related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.
KW - COVID-2019
KW - SARS-CoV-2
KW - maternal mortality
KW - neonatal mortality
KW - pneumonia
KW - pregnancy
KW - preterm birth
KW - small-for-gestational-age
UR - http://www.scopus.com/inward/record.url?scp=85146897897&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2022.08.038
DO - 10.1016/j.ajog.2022.08.038
M3 - Review article
C2 - 36027953
AN - SCOPUS:85146897897
SN - 0002-9378
VL - 228
SP - 161
EP - 177
JO - American Journal of Obstetrics and Gynecology
JF - American Journal of Obstetrics and Gynecology
IS - 2
ER -