Maternal, fetal and neonatal outcomes of large series of SARS-CoV-2 positive pregnancies in peripartum period: a single-center prospective comparative study

Hcini, Najeh; Maamri, Fatma; Picone, Olivier; Carod, Jean-Francois; Lambert, Véronique; Mathieu, Meredith; Carles, Gabriel; Pomar, Léo

OBJECTIVE: To describe the proportions of asymptomatic, mild and severe diseases in infected pregnant women admitted for delivery. To compare maternal, fetal and neonatal outcomes of SARS-CoV-2 infected pregnant women with those of non-infected patients. STUDY DESIGN: Through an universal PCR testing for SARS-COV-2 at admission (not symptoms-based), this prospective cohort study enrolled all pregnant women admitted for delivery between 16(th) of June and the 16(th) of August 2020 in the West French Guiana Hospital Center. RESULTS: 507 pregnant women were included during the study period, of which 137 (27%) were infected with SARS-COV-2. On admission, only 34/137 (24.8%) of these patients presented with clinical symptoms. Among asymptomatic women, 16 /103 (15%) became symptomatic after diagnosis. Throughout the delivery hospitalization and follow-up, 87/137 (63.5 %) remained always asymptomatic, 45/137 (32.8%) developed a mild COVID-19 and 5/137 (3.6 %) developed a severe infection. SARS-CoV-2 infected patients were more likely to have post-partum hemorrhage >500 ml (14.2 % vs 7.2 %, RR 2.0 [95%CI 1.1-3.4]), to be transfused (5.5% vs 1.1 %, RR 4.9 [1.5-16.6]), and to be hospitalized in ICU (3.6% vs 0.8%, RR 4.5 [95%CI 1.1-18.6] than uninfected ones. Intra-uterine fetal demises were more common in infected mothers compared to controls (5.1% vs 1.1%, RR 4.7 [95% CI 1.4-45.9). Among 108 neonates from infected mothers tested at birth, none tested positive (0/108). When tested between 25 and 42 hours after delivery, 4/29 (13.7%) were positive for SARS-CoV-2 RT-PCR on nasopharyngeal swabs and remained asymptomatic. CONCLUSION: Pregnant women admitted for delivery and diagnosed with a SARS-COV-2 infection through an universal screening were symptomatic in only a quarter of cases. Their risks of post-partum hemorrhage, transfusion and admission to ICU were higher than those of uninfected patients. They also presented a higher risk of intra-uterine fetal demise. There were no other differences in maternal, obstetrical or neonatal outcomes.