Pregnancy as a risk factor for severe coronavirus 2019 (COVID-19) disease using standardized clinical criteria

OAKES, Megan C.; KERNBERG, Annessa S.; CARTER, Ebony B.; FOELLER, Megan E.; PALANISAMY, Arvind; RAGHURAMAN, Nandini; KELLY, Jeannie C.

BACKGROUND: As of November 18, 2020, over 11 million people have been infected with coronavirus disease 2019 (COVID-19) and almost 250,000 people have died from the disease in the US, less than one year since its discovery. Although literature is beginning to emerge on pregnancy as a risk factor for severe COVID-19, these studies are heterogeneous and use primary outcomes such as intensive care unit admission or hospitalization as surrogate markers that may subject analyses to misclassification bias in pregnant patients. OBJECTIVE: We aim determine the risk of severe COVID-19 among pregnant women with symptomatic COVID-19 compared to non-pregnant women using non-admission based, standardized clinical criteria for severe disease. STUDY DESIGN: This is a retrospective cohort study of women aged 13-45 years and diagnosed with symptomatic COVID-19 between May 28-July 22, 2020. The primary outcome was severe COVID-19 as defined by two sets of non-admission based, clinical criteria: the World Health Organization Ordinal Scale for Clinical Improvement and the Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. Adjusted risk ratios were estimated using multivariable logistic regression analyses. RESULTS: Of 262 women aged 13-45 years with symptomatic COVID-19, 22 (8.4%) were pregnant and 240 (91.6%) were non-pregnant. After adjusting for covariates potentially associated with the primary outcome, symptomatic pregnant women were at significantly increased risk for severe COVID-19 compared to non-pregnant women using both the World Health Organization Ordinal Scale for Clinical Improvement (aRR 3.59, 95% CI 1.49-7.01) and Novel Coronavirus Pneumonia Emergency Response Epidemiology Team (aRR 5.65, 95% CI 1.36-17.31) criteria. CONCLUSION: Pregnancy significantly increases the risk for severe COVID-19 as defined by non-admission based, clinical criteria.