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The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States.

Publication ,  Journal Article
Katz, D; Bateman, BT; Kjaer, K; Turner, DP; Spence, NZ; Habib, AS; George, RB; Toledano, RD; Grant, G; Madden, HE; Butwick, AJ; Lynde, G ...
Published in: Anesth Analg
August 1, 2021

BACKGROUND: Early reports associating severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with adverse pregnancy outcomes were biased by including only women with severe disease without controls. The Society for Obstetric Anesthesia and Perinatology (SOAP) coronavirus disease 2019 (COVID-19) registry was created to compare peripartum outcomes and anesthetic utilization in women with and without SARS-CoV-2 infection delivering at institutions with widespread testing. METHODS: Deliveries from 14 US medical centers, from March 19 to May 31, 2020, were included. Peripartum infection was defined as a positive SARS-CoV-2 polymerase chain reaction test within 14 days of delivery. Consecutive SARS-CoV-2-infected patients with randomly selected control patients were sampled (1:2 ratio) with controls delivering during the same day without a positive test. Outcomes were obstetric (eg, delivery mode, hypertensive disorders of pregnancy, and delivery <37 weeks), an adverse neonatal outcome composite measure (primary), and anesthetic utilization (eg, neuraxial labor analgesia and anesthesia). Outcomes were analyzed using generalized estimating equations to account for clustering within centers. Sensitivity analyses compared symptomatic and asymptomatic patients to controls. RESULTS: One thousand four hundred fifty four peripartum women were included: 490 with SARS-CoV-2 infection (176 [35.9%] symptomatic) and 964 were controls. SARS-CoV-2 patients were slightly younger, more likely nonnulliparous, nonwhite, and Hispanic than controls. They were more likely to have diabetes, obesity, or cardiac disease and less likely to have autoimmune disease. After adjustment for confounders, individuals experiencing SARS-CoV-2 infection exhibited an increased risk for delivery <37 weeks of gestation compared to controls, 73 (14.8%) vs 98 (10.2%) (adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.03-2.09). Effect estimates for other obstetric outcomes and the neonatal composite outcome measure were not meaningfully different between SARS-CoV-2 patients versus controls. In sensitivity analyses, compared to controls, symptomatic SARS-CoV-2 patients exhibited increases in cesarean delivery (aOR, 1.57; 95% CI, 1.09-2.27), postpartum length of stay (aOR, 1.89; 95% CI, 1.18-2.60), and delivery <37 weeks of gestation (aOR, 2.08; 95% CI, 1.29-3.36). These adverse outcomes were not found in asymptomatic women versus controls. SARS-CoV-2 patients (asymptomatic and symptomatic) were less likely to receive neuraxial labor analgesia (aOR, 0.52; 95% CI, 0.35-0.75) and more likely to receive general anesthesia for cesarean delivery (aOR, 3.69; 95% CI, 1.40-9.74) due to maternal respiratory failure. CONCLUSIONS: In this large, multicenter US cohort study of women with and without peripartum SARS-CoV-2 infection, differences in obstetric and neonatal outcomes seem to be mostly driven by symptomatic patients. Lower utilization of neuraxial analgesia in laboring patients with asymptomatic or symptomatic infection compared to patients without infection requires further investigation.

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

August 1, 2021

Volume

133

Issue

2

Start / End Page

462 / 473

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Risk Factors
  • Risk Assessment
  • Registries
  • Premature Birth
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Infant, Premature
  • Humans
 

Citation

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Chicago
ICMJE
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Katz, D., Bateman, B. T., Kjaer, K., Turner, D. P., Spence, N. Z., Habib, A. S., … Leffert, L. (2021). The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States. Anesth Analg, 133(2), 462–473. https://doi.org/10.1213/ANE.0000000000005592
Katz, Daniel, Brian T. Bateman, Klaus Kjaer, Dana P. Turner, Nicole Z. Spence, Ashraf S. Habib, Ronald B. George, et al. “The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States.Anesth Analg 133, no. 2 (August 1, 2021): 462–73. https://doi.org/10.1213/ANE.0000000000005592.
Katz D, Bateman BT, Kjaer K, Turner DP, Spence NZ, Habib AS, George RB, Toledano RD, Grant G, Madden HE, Butwick AJ, Lynde G, Minehart RD, Beilin Y, Houle TT, Sharpe EE, Kodali B, Bharadwaj S, Farber MK, Palanisamy A, Prabhu M, Gonzales NY, Landau R, Leffert L. The Society for Obstetric Anesthesia and Perinatology Coronavirus Disease 2019 Registry: An Analysis of Outcomes Among Pregnant Women Delivering During the Initial Severe Acute Respiratory Syndrome Coronavirus-2 Outbreak in the United States. Anesth Analg. 2021 Aug 1;133(2):462–473.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

August 1, 2021

Volume

133

Issue

2

Start / End Page

462 / 473

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Risk Factors
  • Risk Assessment
  • Registries
  • Premature Birth
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Infant, Premature
  • Humans