Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications

Publication Description
Importance: It remains unknown whether SARS-CoV-2 infection specifically increases the risk of serious obstetric morbidity. Objective: To evaluate the association of SARS-CoV-2 infection with serious mate morbidity or mortality from common obstetric complications. Design, Setting, and Participants: Retrospective cohort study of 14104 pregnant and postpartum patients delivered between March 1, 2020, and December 31, 2020 (with final follow-up to February 11, 2021), at 17 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Gestational Research Assessments of COVID-19 (GRAVID) Study. All patients with SARS-CoV-2 were included and compared with those without a positive SARS-CoV-2 test result who delivered on randomly selected dates over the same period. Exposures: SARS-CoV-2 infection was based on a positive nucleic acid or antigen test result. Secondary analyses further stratified those with SARS-CoV-2 infection by disease severity. Main Outcomes and Measures: The primary outcome was a composite of maternal death or serious morbidity related to hypertensive disorders of pregnancy, postpartum hemorrhage, or infection other than SARS-CoV-2. The main secondary outcome was cesarean birth. Results: Of the 14104 included patients (mean age, 29.7 years), 2352 patients had SARS-CoV-2 infection and 11752 did not have a positive SARS-CoV-2 test result. Compared with those without a positive SARS-CoV-2 test result, SARS-CoV-2 infection was significantly associated with the primary outcome (13.4% vs 9.2%; difference, 4.2% [95% CI, 2.8%-5.6%]; adjusted relative risk [aRR], 1.41 [95% CI, 1.23-1.61]). All 5 maternal deaths were in the SARS-CoV-2 group. SARS-CoV-2 infection was not significantly associated with cesarean birth (34.7% vs 32.4%; aRR, 1.05 [95% CI, 0.99-1.11]). Compared with those without a positive SARS-CoV-2 test result, moderate or higher COVID-19 severity (n = 586) was significantly associated with the primary outcome (26.1% vs 9.2%; difference, 16.9% [95% CI, 13.3%-20.4%]; aRR, 2.06 [95% CI, 1.73-2.46]) and the major secondary outcome of cesarean birth (45.4% vs 32.4%; difference, 12.8% [95% CI, 8.7%-16.8%]; aRR, 1.17 [95% CI, 1.07-1.28]), but mild or asymptomatic infection (n = 1766) was not significantly associated with the primary outcome (9.2% vs 9.2%; difference, 0% [95% CI, -1.4% to 1.4%]; aRR, 1.11 [95% CI, 0.94-1.32]) or cesarean birth (31.2% vs 32.4%; difference, -1.4% [95% CI, -3.6% to 0.8%]; aRR, 1.00 [95% CI, 0.93-1.07]). Conclusions and Relevance: Among pregnant and postpartum individuals at 17 US hospitals, SARS-CoV-2 infection was associated with an increased risk for a composite outcome of maternal mortality or serious morbidity from obstetric complications.

Primary Author
Metz,T. D.
Clifton,R. G.
Hughes,B. L.
Sandoval,G. J.
Grobman,W. A.
Saade,G. R.
Manuck,T. A.
Longo,M.
Sowles,A.
Clark,K.
Simhan,H. N.
Rouse,D. J.
Mendez-Figueroa,H.
Gyamfi-Bannerman,C.
Bailit,J. L.
Costantine,M. M.
Sehdev,H. M.
Tita,A. T. N.
Macones,G. A.
National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network

Author Address
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City.; George Washington University Biostatistics Center, Washington, DC.; Division of Maternal-Fetal Medicine, Department of Obst(TRUNCATED)

Author Address
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City.; George Washington University Biostatistics Center, Washington, DC.; Division of Maternal-Fetal Medicine, Department of Obst(TRUNCATED)

PMID
35129581



Reference Type
Journal Article

Periodical Full
Jama

Publication Year
2022

Publication Date
7-Feb

Place of Publication
United States

ISSN/ISBN
1538-3598

Document Object Index
10.1001/jama.2022.1190 [doi]

Accession Number
PMID: 35129581