Pregnant Women With COVID-19 Have Higher Mortality Rates Than Similarly Aged Adults

January 28, 2021

Coronavirus disease 2019 (COVID-19) hospitalisation and case fatality rates in pregnant patients were significantly higher compared with similarly aged adults in Washington State with COVID-19, according to a study published in the American Journal of Obstetrics and Gynecology.

Among 240 pregnant women in Washington State who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 1, 2020, and June 30, 2020, 1 in 11 developed severe or critical disease, 1 in 10 were hospitalised for COVID-19, and 1 in 80 died.

The COVID-19-associated hospitalisation rate was 3.5-fold higher than in similarly-aged adults in Washington State (10.0% vs 2.8%), and the COVID-19 case fatality in pregnancy was a significant 13.6-fold higher, with an absolute difference in mortality rate of 1.2%.

The 3 women who died of COVID-19 were from minority ethnic groups, and most of them had other conditions such as obesity and hypertension.

“The case fatality rate in pregnant and recently pregnant patients with SARS-CoV-2 infections of 1,250/100,000 pregnancies is in stark contrast to the Washington State maternal mortality rate of 37.3/100,000 live births and pregnancy-related maternal mortality rate of 11.2/100,000 live births,” wrote Adams Waldorf, MD, University of Washington, Seattle, Washington.

The pregnant patients with COVID-19 were identified from 35 sites in Washington State, which captured 61% of annual state deliveries. Case fatality rates in pregnancy were compared with COVID-19 fatality rates in similarly aged adults in Washington. Maternal and neonatal outcomes were compared by trimester of infection and disease severity at the time of delivery.

Preterm birth was significantly higher among women with severe/critical COVID-19 at delivery than for women who had recovered from mild COVID-19 (45.4% vs 5.2%, respectively; P

“We are gravely concerned that COVID-19-associated maternal deaths have been massively undercounted nationally and that the impact on pregnant patients, particularly with underlying conditions is greater than currently underappreciated,” said Dr. Waldorf.

“These results suggest that the exclusion of pregnant patients from COVID-19 vaccine trials was a mistake,” she added. Here is an important group that is typically highly vulnerable to influenza infections and, yet they were excluded from COVID-19 vaccine trials. Pregnant patients should have been given the option to enrol in vaccine trials so that we would better understand vaccine risks and benefits to them.”

Reference: https://www.ajog.org/article/S0002-9378(21)00033-8/pdf

SOURCE: University of Washington Health Science