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The associations between COVID-19 and maternal birth outcomes are poorly understood. To examine interactions between COVID-19 status, comorbidities, and hospital events among women giving birth, investigators analyzed a national database that includes all insurance payers and approximately 20% of U.S. hospitalizations.
Of the approximately 400,000 women hospitalized for delivery from April 1 to November 23, 2020, 1.6% were diagnosed with COVID-19. Having COVID-19 compared with not having the infection was associated with significantly greater risks for cesarean delivery (28.9% vs. 27.5%), preterm labor (5.2% vs. 4.0%), preeclampsia (8.8% vs. 6.8%), HELLP syndrome (preeclampsia with hemolysis, elevated liver enzymes with low platelet count; 0.5% vs. 0.2%), venous thromboembolism (0.2% vs. 0.1%), and mechanical ventilation (1.3% vs. 0.1%). COVID-19 was associated with a markedly higher death rate (141 vs. 5 deaths per 100,000 births). Among women with COVID-19, the risk factors most strongly associated with needing mechanical ventilation or in-hospital death were eclampsia, thrombotic events, and stillbirth, as well as older age, morbid obesity, diabetes, and kidney disease.
Jering KS et al. Clinical characteristics and outcomes of hospitalized women giving birth with and without COVID-19. JAMA Intern Med 2021 Jan 15; [e-pub]. (https://doi.org/10.1001/jamainternmed.2020.9241)
Comment
This study, one of the largest on the impact of COVID-19 among U.S. women hospitalized for birth, links COVID-19 to many adverse maternal outcomes. It is especially important for pregnant women to strictly adhere to the well-known practices that decrease the risk for COVID-19. Clinicians in my practice favor giving the COVID-19 vaccine to pregnant women, and we discuss with them the pros and cons of the vaccine, as is recommended by the American College of Obstetricians and Gynecologists.