Objectives: To evaluate maternal and perinatal outcomes in high compared to low-risk pregnancies complicated by SARS-COV-2 infection. Methods: This was a multinational retrospective cohort study including women with laboratory-confirmed SARS-COV-2 from 76 centers from 25 different countries in Europe, United States, South America, Asia and Australia from 04 April 2020 till 28 October 2020. The primary outcome was a composite measure of maternal mortality and morbidity including admission to intensive care unit (ICU), use of mechanical ventilation, or death. Secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal (NND) and perinatal (PND) death, and admission to neonatal intensive care unit. All these outcomes were assessed in high-risk compared to low-risk pregnancies. Pregnancies were considered as high risk in case of either pre-existing chronic medical conditions pre-existing pregnancy or obstetric disorders occurring in pregnancy. Fisher-test and logistic regression analysis were used to analyze the data. Results: 887 singleton pregnancies tested positive to SARS-COV-2 at RT-PCR nasal and pharyngeal swab were included in the study. The risk of composite adverse maternal outcome was higher in high compared to low risk-pregnancies with an OR of 1.52 (95% CU 1.03-2.24; p= 0.035). Likewise, women carrying a high risk-pregnancies were also at higher risk of hospital admission (OR: 1.48, 95% CI 1.07-2.04; p= 0.002), presence of severe respiratory symptoms (OR: 2.13, 95% CI .41-3.21; p= 0.001), admission to ICU (OR: 2.63, 95% CI 1.42-4.88) and invasive mechanical ventilation (OR: 2.65, 95% CI 1.19- 5.94; p= .002). When exploring perinatal outcomes, high-risk pregnancies were also at high risk of adverse perinatal outcome with an OR 0f 1.78 (95% CI .15-2.72; p= 0.009). However, such association was mainly due to the higher incidence of miscarriage in high risk compared to low risk pregnancies (5.3% vs 1.6%, p= 0.008), while there was no difference as regard as the other explored outcomes between the two study groups. At logistic regression analysis, maternal age (OR: 1.12, 95% CI 1.02-1.22, p= 0.023) and the presence of a high-risk pregnancies (OR: 4.21, 95% CI 3.90-5.11, p<0.001) were independently associated with adverse maternal outcome. Conclusions: High-risk pregnancies complicated by SARS-COV-2 infection are at higher risk of adverse maternal outcome compared to low-risk gestations.
Maternal and perinatal outcomes in high vs low risk-pregnancies affected by SARS-COV-2 infection (Phase-2): The WAPM (World Association of Perinatal Medicine) working group on COVID-19 / D'Antonio, Francesco; Sen, Cihat; Mascio, Daniele DI; Galindo, Alberto; Villalain, Cecilia; Herraiz, Ignacio; Arısoy, Resul; Ovayolu, Ali; Eroğlu, Hasan; Canales, Manuel Guerra; Ladella, Subhashini; Cojocaru, Liviu; Turan, Ozhan; Turan, Sifa; Hadar, Eran; Brzezinski-Sinai, Noa A; Dollinger, Sarah; Uyaniklar, Ozlem; Ocakouglu, Sakine Rahimli; Atak, Zeliha; Premru-Srsen, Tanja; Kornhauser-Cerar, Lilijana; Druškovič, Mirjam; Ples, Liana; Gündüz, Reyhan; Ağaçayak, Elif; Schvartzman, Javier Alfonso; Malbran, Mercedes Negri; Liberati, Marco; Sebastiano, Francesca Di; Oronzi, Ludovica; Cerra, Chiara; Buca, Danilo; Cagnacci, Angelo; Ramone, Arianna; Barra, Fabio; Carosso, Andrea; Benedetto, Chiara; Cosma, Stefano; Pintiaux, Axelle; Daelemans, Caroline; Costa, Elena; Özel, Ayşegül; Muhçu, Murat; Jimenez Lopez, Jesús S; Alvarado, Clara; Piqueras, Anna Luengo; Oliva, Dolores Esteban; Schera, Giovanni Battista Luca; Volpe, Nicola; Frusca, Tiziana; Samardjiski, Igor; Simeonova, Slagjana; Papestiev, Irena Aleksioska; Hojman, Javier; Turkcuoglu, Ilgin; Cromi, Antonella; Laganà, Antonio Simone; Ghezzi, Fabio; Sirico, Angelo; Familiari, Alessandra; Scambia, Giovanni; Sukhikh, Zulfiya Khodjaeva Gennady T; Gorina, Ksenia A; de Sa, Renato Augusto Moreira; Vaz, Mariana; Feuerschuette, Otto Henrique May; Gatta, Anna Nunzia Della; Youssef, Aly; Donna, Gaetana Di; Martinez-Varea, Alicia; Loscalzo, Gabriela; Roselló, José Morales; Stefanovic, Vedran; Nupponen, Irmeli; Nelskylä, Kaisa; Ayala, Rodrigo; Molpeceres, Rebeca Garrote; Vázquez, Asunción Pino; Sandri, Fabrizio; Cataneo, Ilaria; Lenzi, Marinella; Haberal, Esra Tustas; Huertas, Erasmo; Sanchez, Amadeo; Arango, Pedro; Bermejo, Amanda; Alcantara, María Monica Gonzalez; Göynümer, Gökhan; Okuyan, Erhan; Madalina, Ciuhodaru; Guisan, Ana Concheiro; Schulte, Alejandra Martínez; Esposito, Valentina; De Robertis, Valentina; Zdjelar, Snezana; Lackovic, Milan; Mihajlovic, Sladjana; Jekova, Nelly; Saccone, Gabriele; Aslan, Mehmet Musa; Dedda, Maria Carmela Di; Chalid, Maisuri; Canache, Jose Enrique Moros; Daskalakis, George; Antsaklis, Panos; Vega, Enrique Criado; Cueto, Elisa; Taccaliti, Chiara; Aykanat, Alicia Yeliz; Özlem Genç, Şerife; Froessler, Bernd; Radulova, Petya Angelova; Morano, Danila; Bianchi, Beatrice; Marino, Maria Giulia Lombana; Meccariello, Gabriella; Rohatgi, Bindu; Schiattarella, Antonio; Morlando, Maddalena; Colacurci, Nicola; Villasco, Andrea; Biglia, Nicoletta; Marques, Ana Luiza Santos; Gatti, Alessandra; Luvero, Daniela; Angioli, Roberto; Pittaro, Alejandro; Lila, Albert; Zlatohlávková, Blanka. - In: AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY, MATERNAL-FETAL MEDICINE. - ISSN 2589-9333. - (2021), p. 100329. [10.1016/j.ajogmf.2021.100329]
Maternal and perinatal outcomes in high vs low risk-pregnancies affected by SARS-COV-2 infection (Phase-2): The WAPM (World Association of Perinatal Medicine) working group on COVID-19
Sirico, Angelo;Saccone, Gabriele;
2021
Abstract
Objectives: To evaluate maternal and perinatal outcomes in high compared to low-risk pregnancies complicated by SARS-COV-2 infection. Methods: This was a multinational retrospective cohort study including women with laboratory-confirmed SARS-COV-2 from 76 centers from 25 different countries in Europe, United States, South America, Asia and Australia from 04 April 2020 till 28 October 2020. The primary outcome was a composite measure of maternal mortality and morbidity including admission to intensive care unit (ICU), use of mechanical ventilation, or death. Secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal (NND) and perinatal (PND) death, and admission to neonatal intensive care unit. All these outcomes were assessed in high-risk compared to low-risk pregnancies. Pregnancies were considered as high risk in case of either pre-existing chronic medical conditions pre-existing pregnancy or obstetric disorders occurring in pregnancy. Fisher-test and logistic regression analysis were used to analyze the data. Results: 887 singleton pregnancies tested positive to SARS-COV-2 at RT-PCR nasal and pharyngeal swab were included in the study. The risk of composite adverse maternal outcome was higher in high compared to low risk-pregnancies with an OR of 1.52 (95% CU 1.03-2.24; p= 0.035). Likewise, women carrying a high risk-pregnancies were also at higher risk of hospital admission (OR: 1.48, 95% CI 1.07-2.04; p= 0.002), presence of severe respiratory symptoms (OR: 2.13, 95% CI .41-3.21; p= 0.001), admission to ICU (OR: 2.63, 95% CI 1.42-4.88) and invasive mechanical ventilation (OR: 2.65, 95% CI 1.19- 5.94; p= .002). When exploring perinatal outcomes, high-risk pregnancies were also at high risk of adverse perinatal outcome with an OR 0f 1.78 (95% CI .15-2.72; p= 0.009). However, such association was mainly due to the higher incidence of miscarriage in high risk compared to low risk pregnancies (5.3% vs 1.6%, p= 0.008), while there was no difference as regard as the other explored outcomes between the two study groups. At logistic regression analysis, maternal age (OR: 1.12, 95% CI 1.02-1.22, p= 0.023) and the presence of a high-risk pregnancies (OR: 4.21, 95% CI 3.90-5.11, p<0.001) were independently associated with adverse maternal outcome. Conclusions: High-risk pregnancies complicated by SARS-COV-2 infection are at higher risk of adverse maternal outcome compared to low-risk gestations.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
