TY - JOUR
T1 - Association of SARS-CoV-2 infection with serious maternal morbidity and mortality from obstetric complications
AU - for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network
AU - Metz, Torri D.
AU - Clifton, Rebecca G.
AU - Hughes, Brenna L.
AU - Sandoval, Grecio J.
AU - Grobman, William A.
AU - Saade, George R.
AU - Manuck, Tracy A.
AU - Longo, Monica
AU - Sowles, Amber
AU - Clark, Kelly
AU - Simhan, Hyagriv N.
AU - Rouse, Dwight J.
AU - Mendez-Figueroa, Hector
AU - Gyamfi-Bannerman, Cynthia
AU - Bailit, Jennifer L.
AU - Costantine, Maged M.
AU - Sehdev, Harish M.
AU - Tita, Alan T.N.
AU - Macones, George A.
N1 - Funding Information:
receiving personal fees from Pfizer for her role as a medical consultant for a study of SARS-CoV-2 vaccination in pregnancy and grants from Pfizer for her roles as a site principal investigator [PI] for a study of SARS-CoV-2 vaccination in pregnancy and as a site PI for a study of respiratory syncytial virus vaccination in pregnancy, and from Gestvision for her role as a site PI for a preeclampsia study outside the submitted work. Dr Hughes reported receiving personal fees from Merck outside the submitted work. Dr Simhan reported being the co-founder of Naima Health LLC and receiving personal fees from UpToDate outside the submitted work. Dr Costantine reported relationships with Baxter International, Momenta Pharmaceuticals, Progenity, AMAG Pharmaceuticals, and ObsEva. Dr Tita reported receiving grants from Pfizer for a COVID-19 in pregnancy trial outside the submitted work. No other disclosures were reported.
Funding Information:
Funding Support: This work is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (grants UG1 HD087230, UG1 HD027869, UG1 HD027915, UG1 HD034208, UG1 HD040500, UG1 HD040485, UG1 HD053097, UG1HD040544, UG1 HD040545, UG1 HD040560, UG1 HD040512, UG1 HD087192, and U10 HD036801) and the National Center for Advancing Translational Sciences (grant UL1TR001873).
Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/2/22
Y1 - 2022/2/22
N2 - 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 maternal morbidity or mortality from common obstetric complications. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 14 104 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 14 104 included patients (mean age, 29.7 years), 2352 patients had SARS-CoV-2 infection and 11 752 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.
AB - 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 maternal morbidity or mortality from common obstetric complications. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 14 104 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 14 104 included patients (mean age, 29.7 years), 2352 patients had SARS-CoV-2 infection and 11 752 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.
UR - http://www.scopus.com/inward/record.url?scp=85124398218&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85124398218&partnerID=8YFLogxK
U2 - 10.1001/jama.2022.1190
DO - 10.1001/jama.2022.1190
M3 - Article
C2 - 35129581
AN - SCOPUS:85124398218
VL - 327
SP - 748
EP - 759
JO - JAMA: The Journal of the American Medical Association
JF - JAMA: The Journal of the American Medical Association
SN - 0098-7484
IS - 8
ER -