This multinational study shows that women with COVID are 50% more likely to have complications during pregnancy, but if COVID is asymptomatic the risk is the same as if they did not have the infection

Key Points

Question: To what extent does COVID-19 in pregnancy alter the risks of adverse maternal and neonatal outcomes compared with pregnant individuals without COVID-19?

Findings: Women with COVID-19 diagnosis were at increased risk of a composite maternal morbidity and mortality index. Newborns of women with COVID-19 diagnosis had significantly higher severe neonatal morbidity index and severe perinatal morbidity and mortality index compared with newborns of women without COVID-19 diagnosis.


Figures of some of the results obtained

Gestational Age at Delivery Among Women With COVID-19 Diagnosis, With and Without Symptoms, and Women Without COVID-19 Diagnosis.
Pregnancy Complications, Perinatal Events, and Neonatal Morbidities Among Women With and Without COVID-19 Diagnosis and Their Newborns.

Description of the Study:

  • Title: Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection.
  • Principal Investigators: José Villar, Shabina Ariff, Robert B. Gunier, et al.
  • Centers of Implementation: It is coordinated from the University of Oxford with the participation of more than 43 institutions in 18 countries (Hospital Universitario Vall d’Hebron, Hospital Clínico Universitario Lozano Blesa de Zaragoza and others).
  • Study Population: Women 18 years or older at any stage of pregnancy or delivery with the diagnosis of COVID-19 during the present pregnancy based on laboratory confirmation of COVID-19 and/or radiologic pulmonary findings suggestive of COVID-19 or 2 or more predefined COVID-19 symptoms.
  • Study Type: Large-scale, prospective, multinational cohort study.
  • Design: This study took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge.

Objectives of the Study:

Principal Objective: To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals.

More about this Study:

At the outset of the COVID-19 pandemic, the precise extent of the risks in pregnancy was uncertain, which was affecting pregnant individuals’ mental health. The lack of clarity arose because, in an early systematic review, only 4 studies that involved small numbers compared outcomes between pregnant women with and without COVID-19. The question is relevant because of the known deleterious effects of other coronavirus infections in pregnancy (eg, severe acute respiratory syndrome and Middle East respiratory syndrome).

The results mostly reflect COVID-19 diagnosed in the third trimester. Thus, women with COVID-19 diagnosis or whose pregnancy ended earlier in pregnancy are underrepresented either because the study was exclusively hospital based or earlier infection may manifest with mild symptoms, which are either ignored or managed in primary care. Alternatively, most women might have avoided the hospital until late in pregnancy or when in labor. Clearly, the effect of COVID-19 early in pregnancy needs urgently to be studied.


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