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Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications.

Publication ,  Journal Article
Metz, TD; Clifton, RG; Hughes, BL; Sandoval, GJ; Grobman, WA; Saade, GR; Manuck, TA; Longo, M; Sowles, A; Clark, K; Simhan, HN; Rouse, DJ ...
Published in: JAMA
February 22, 2022

IMPORTANCE: It remains unknown whether SARS-CoV-2 infection specifically increases the risk of serious obstetric morbidity. OBJECTIVE: To evaluate the association of SARS-CoV-2 infection with serious maternal morbidity or mortality from common obstetric complications. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 14 104 pregnant and postpartum patients delivered between March 1, 2020, and December 31, 2020 (with final follow-up to February 11, 2021), at 17 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Gestational Research Assessments of COVID-19 (GRAVID) Study. All patients with SARS-CoV-2 were included and compared with those without a positive SARS-CoV-2 test result who delivered on randomly selected dates over the same period. EXPOSURES: SARS-CoV-2 infection was based on a positive nucleic acid or antigen test result. Secondary analyses further stratified those with SARS-CoV-2 infection by disease severity. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of maternal death or serious morbidity related to hypertensive disorders of pregnancy, postpartum hemorrhage, or infection other than SARS-CoV-2. The main secondary outcome was cesarean birth. RESULTS: Of the 14 104 included patients (mean age, 29.7 years), 2352 patients had SARS-CoV-2 infection and 11 752 did not have a positive SARS-CoV-2 test result. Compared with those without a positive SARS-CoV-2 test result, SARS-CoV-2 infection was significantly associated with the primary outcome (13.4% vs 9.2%; difference, 4.2% [95% CI, 2.8%-5.6%]; adjusted relative risk [aRR], 1.41 [95% CI, 1.23-1.61]). All 5 maternal deaths were in the SARS-CoV-2 group. SARS-CoV-2 infection was not significantly associated with cesarean birth (34.7% vs 32.4%; aRR, 1.05 [95% CI, 0.99-1.11]). Compared with those without a positive SARS-CoV-2 test result, moderate or higher COVID-19 severity (n = 586) was significantly associated with the primary outcome (26.1% vs 9.2%; difference, 16.9% [95% CI, 13.3%-20.4%]; aRR, 2.06 [95% CI, 1.73-2.46]) and the major secondary outcome of cesarean birth (45.4% vs 32.4%; difference, 12.8% [95% CI, 8.7%-16.8%]; aRR, 1.17 [95% CI, 1.07-1.28]), but mild or asymptomatic infection (n = 1766) was not significantly associated with the primary outcome (9.2% vs 9.2%; difference, 0% [95% CI, -1.4% to 1.4%]; aRR, 1.11 [95% CI, 0.94-1.32]) or cesarean birth (31.2% vs 32.4%; difference, -1.4% [95% CI, -3.6% to 0.8%]; aRR, 1.00 [95% CI, 0.93-1.07]). CONCLUSIONS AND RELEVANCE: Among pregnant and postpartum individuals at 17 US hospitals, SARS-CoV-2 infection was associated with an increased risk for a composite outcome of maternal mortality or serious morbidity from obstetric complications.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

February 22, 2022

Volume

327

Issue

8

Start / End Page

748 / 759

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Postpartum Period
  • Postpartum Hemorrhage
  • Maternal Mortality
  • Hypertension, Pregnancy-Induced
  • Humans
  • General & Internal Medicine
 

Citation

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Metz, T. D., Clifton, R. G., Hughes, B. L., Sandoval, G. J., Grobman, W. A., Saade, G. R., … National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network, . (2022). Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications. JAMA, 327(8), 748–759. https://doi.org/10.1001/jama.2022.1190
Metz, Torri D., Rebecca G. Clifton, Brenna L. Hughes, Grecio J. Sandoval, William A. Grobman, George R. Saade, Tracy A. Manuck, et al. “Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications.JAMA 327, no. 8 (February 22, 2022): 748–59. https://doi.org/10.1001/jama.2022.1190.
Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR, et al. Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications. JAMA. 2022 Feb 22;327(8):748–59.
Metz, Torri D., et al. “Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications.JAMA, vol. 327, no. 8, Feb. 2022, pp. 748–59. Pubmed, doi:10.1001/jama.2022.1190.
Metz TD, Clifton RG, Hughes BL, Sandoval GJ, Grobman WA, Saade GR, Manuck TA, Longo M, Sowles A, Clark K, Simhan HN, Rouse DJ, Mendez-Figueroa H, Gyamfi-Bannerman C, Bailit JL, Costantine MM, Sehdev HM, Tita ATN, Macones GA, National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications. JAMA. 2022 Feb 22;327(8):748–759.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

February 22, 2022

Volume

327

Issue

8

Start / End Page

748 / 759

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Postpartum Period
  • Postpartum Hemorrhage
  • Maternal Mortality
  • Hypertension, Pregnancy-Induced
  • Humans
  • General & Internal Medicine