Adverse pregnancy outcomes among Spanish women hospitalised with COVID-19

Polly Clayden, HIV i-Base

High proportion of Caesarean sections and preterm delivery among pregnant women with COVID-19 in a Spanish cohort – according to data presented at HIV Glasgow 2020.

There was no vertical transmission in this study but one reported case of horizontal transmission through family contact.

This main objective of this analysis was to describe clinical and epidemiological characteristics of a cohort of women with SARS‐CoV‐2 during pregnancy and their neonates. It was a prospective, multicentre, observational study of five hospitals in the GESNEO‐COVID cohort.

The study enrolled women with confirmed SARS‐CoV‐2 by PCR and/or serology during pregnancy, diagnosed and delivering between 15 March and 31 July 2020 – there were 105 women included.

The median age of pregnant women was 34.1 (IQR 28.8 to 37.1) years. The majority (93.3%) were diagnosed in the third trimester and remainder (6.7%) during the second trimester. Over half (64.8%) had symptoms, 30.8% of pneumonia. Almost half of the cohort (43.8%) received treatment for COVID‐19 and 4.8% were admitted to ICU, for a median of 10 days (IQR 6.5 to 18.5).

Overall, 36.2% of pregnant women had a Caesarean delivery. Severe COVID‐19 was indicated for almost 30% of them.

There were two sets of twins so 107 neonates were included in the analysis.

The rate of preterm delivery was 20.2% and small for gestational age was 5.6%. The proportion neonates needing intensive care was 16.8%, for a median duration of 3 days (IQR 1 to 8) – mostly due to complications with prematurity. And 66.4% of neonates were breastfed.

One extremely preterm neonate died at 20 days of life due to prematurity-related complications. Another full-term infant died due to unexpected sudden death during early skin-to-skin contact after delivery. Both were born to women with severe pneumonia, admitted to ICU.

Nasopharyngeal PCR was performed at birth and 100% of neonates tested were negative. One neonate then tested positive at 15 days of life. The mother was in the ICU with pneumonia – this was considered to be intra-family transmission. No vertical transmission was reported.

In multivariate analysis pneumonia was associated with higher risk of Caesarean section: OR 4.2 (95% CI 1.47 to 11.99).

Pneumonia and positive PCR at delivery were associated with preterm delivery: OR 6.73 (95% CI 2.30 to 21.31) and OR 6.44 (95% CI 1.82 to 31.38), respectively.

Reference

Carrasco I et al. SARS-CoV-2 infection in pregnancy and newborn in a Spanish multicentriccohort (GESNEO-COVID).  HIV Glasgow – virtual. 5–8 October 2020. Oral abstract 0444.
https://vimeo.com/466268384/be0793cb39 (webcast: 40.45)