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Smaller series have reported excess risk for adverse perinatal outcomes associated with COVID-19 in pregnancy. Investigators conducted a retrospective cohort study of 1219 pregnant women infected with SARS-CoV-2 who delivered by July 31, 2020, at one of the 33 hospitals associated with an NIH-sponsored maternal-fetal medicine network. Disease state was asymptomatic (47%), mild (27%), moderate (14%), severe (8%), or critical (4%); 4 patients (0.3%) died from COVID-19. Women with severe or critical disease were more likely to have higher body-mass index and comorbid conditions, especially pregestational diabetes (10% [severe or critical] vs. 3% [asymptomatic]) and hypertension (11% vs. 5%).
Cesarean delivery (adjusted relative risk, 1.6), hypertensive disorders of pregnancy (aRR, 1.6), and preterm birth (aRR, 3.5) were more common among patients with severe or critical COVID-19 than among those who were asymptomatic. Venous thromboembolism was diagnosed in 6% of women with severe or critical illness and in no asymptomatic women.
Metz TD et al. Disease severity and perinatal outcomes of pregnant patients with coronavirus disease 2019 (COVID-19). Obstet Gynecol 2021 Apr 1; 137:571. (https://doi.org/10.1097/AOG.0000000000004339)
Comment
Recently, most U.S. states have added pregnancy to the list of vaccine eligibility criteria, a recommendation driven by increased risk for adverse outcomes in pregnant people with COVID-19. Absence of clinical trial data on vaccines during pregnancy has provoked concern about this preventive approach. I recommend SARS-CoV-2 vaccination for pregnant people to protect both mother and neonate. We know that, during pregnancy, vaccines against infections such as influenza and pertussis safely improve outcomes — a benefit that will probably also hold true for SARS-CoV-2 vaccines.