Pregnancy and postpartum outcomes in a universally tested population for SARS‐CoV‐2 in New York City: A prospective cohort study – Prabhu – Wiley

Objective
To describe differences in outcomes between pregnant women with and without COVID19
Design
Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for SARSCoV2 using reverse transcriptase polymerase chain reaction (RTPCR). All infants of mothers with COVID19 underwent SARSCoV2 testing.
Setting
Three New York City hospitals
Population
Pregnant women > 20 weeks gestation admitted for delivery
Methods
Data were stratified by SARSCoV2 result and symptomatic status, and summarized using parametric and nonparametric tests.
Main Outcome Measures
Prevalence and outcomes of maternal COVID19; obstetric outcomes; neonatal SARSCoV2; placental pathology.
Results
Of 675 women admitted for delivery, 10.4% were positive for SARSCoV2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities between women with symptomatic vs. asymptomatic vs. no COVID19. Cesarean delivery rates were 46.7% in symptomatic COVID19, 45.5% in asymptomatic COVID19, and 30.9% without COVID19 (p=0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID19 vs 4.5% of women without COVID19 (p<0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARSCoV2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with vs. without COVID19 (48.3% vs 11.3%, p <0.001).
Conclusion
Among pregnant women with COVID19 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 COVID19 infections remote from delivery.

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