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Objective
To describe differences in outcomes between pregnant women with and without COVID‐19
Design
Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for SARS‐CoV‐2 using reverse transcriptase polymerase chain reaction (RT‐PCR). All infants of mothers with COVID‐19 underwent SARS‐CoV‐2 testing.
Setting
Three New York City hospitals
Population
Pregnant women > 20 weeks’ gestation admitted for delivery
Methods
Data were stratified by SARS‐CoV‐2 result and symptomatic status, and summarized using parametric and nonparametric tests.
Main Outcome Measures
Prevalence and outcomes of maternal COVID‐19; obstetric outcomes; neonatal SARS‐CoV‐2; placental pathology.
Results
Of 675 women admitted for delivery, 10.4% were positive for SARS‐CoV‐2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities between women with symptomatic vs. asymptomatic vs. no COVID‐19. Cesarean delivery rates were 46.7% in symptomatic COVID‐19, 45.5% in asymptomatic COVID‐19, and 30.9% without COVID‐19 (p=0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID‐19 vs 4.5% of women without COVID‐19 (p<0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS‐CoV‐2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with vs. without COVID‐19 (48.3% vs 11.3%, p <0.001).
Conclusion
Among pregnant women with COVID‐19 at delivery, we observed increased cesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID‐19 infections remote from delivery.
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