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Intensive care unit admissions for pregnant and nonpregnant women with coronavirus disease 2019

      Objective

      Early reports indicate that pregnant women are not at an increased risk for coronavirus disease 2019 (COVID-19) or for a worse disease course if infection occurs.
      • Rasmussen S.A.
      • Smulian J.C.
      • Lednicky J.A.
      • Wen T.S.
      • Jamieson D.J.
      Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know.
      • Della Gatta A.N.
      • Rizzo R.
      • Pilu G.
      • Simonazzi G.
      COVID19 during pregnancy: a systematic review of reported cases.
      • Yan J.
      • Guo J.
      • Fan C.
      • et al.
      Coronavirus disease 2019 (COVID-19) in pregnant women: a report based on 116 cases.
      This study aimed to review our experiences with intensive care unit (ICU) admissions of women of reproductive age with COVID-19, and to determine whether pregnant women are more likely to be admitted to the ICU than nonpregnant women.

      Study Design

      We evaluated data from a large hospital system in New York State between March 2, 2020, and April 9, 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing was performed on acutely symptomatic patients presenting with characteristic respiratory signs and symptoms.
      Centers for Disease Control and Prevention
      Symptoms of coronavirus.
      Nasopharyngeal specimens were obtained, and microbiologic diagnosis was made on the basis of a positive result on SARS-CoV-2 real-time reverse transcription polymerase chain reaction (RT-PCR) assay. We included only patients of reproductive age (15–49 years) who were admitted to 1 of 7 hospitals in our system and who received a diagnosis of COVID-19 by RT-PCR on admission, during the hospital stay, or during the postpartum period. Data analyzed in this study included age (5 age groups between 15 and 49 years), pregnancy status, and admission to an ICU. We excluded patients with incomplete data. The incidence of ICU admission was compared between pregnant and nonpregnant women with COVID-19 in each age group. Patients were admitted to the ICU at the discretion of the consulted critical care attending physician. Other clinical characteristics, including medical comorbidities, were not evaluated and not necessarily the same. The institutional review board determined that this study did not meet the definition of human subjects research and was exempt from formal review.

      Results

      Among all patients between the ages of 15–49 years admitted at 7 hospitals within our health system between March 4, 2020, and April 9, 2020, there were 1168 symptomatic patients who received a diagnosis of COVID-19. Of these, 754 (64.6%) were male, 332 (28.4%) were nonpregnant females, and 82 (7.0%) were pregnant females. During this time period, 2971 pregnant patients were admitted, primarily for delivery. In some cases, symptomatic patients with a diagnosis of COVID-19 (2.8%) were admitted for obstetrical indications and only had mild respiratory disease. In all, 50 nonpregnant females (15.1%, 50 of 332) and 8 pregnant females (9.8%, 8 of 82) were admitted to the ICU for worsening respiratory status, with no statistically significant difference (P=.22). ICU admissions by age group are presented in the Table.
      TableICU admissions by age group in pregnant and nonpregnant women with COVID-19
      Age group, yPregnant women (n=82)Nonpregnant women (n=332)P value
      <251/11 (9.1)3/7 (42.9).09
      25–290/17 (0)5/40 (12.5).16
      30–342/33 (6.1)5/44 (11.4).46
      35–393/15 (20.0)9/55 (16.4).73
      40–492/6 (33.3)28/190 (14.7).28
      Total8/82 (9.8)50/332 (15.1).22
      Values are presented as n/N (%).
      COVID-19, coronavirus disease 2019; ICU, intensive care unit.
      Blitz. ICU admissions for pregnant and nonpregnant women with COVID-19. Am J Obstet Gynecol 2020.

      Conclusion

      Among hospitalized women who received a diagnosis of COVID-19, pregnant women were not at an increased risk for ICU admission compared with nonpregnant women. This finding is consistent with the overall lower hospital admission rate of pregnant women with COVID-19 that we previously reported.
      • Tekbali A.
      • Grünebaum A.
      • Saraya A.
      • McCullough L.
      • Bornstein E.
      • Chervenak F.A.
      Pregnant versus non-pregnant SARS-CoV-2 and COVID-19 hospital admissions: the first 4 weeks in New York.
      Pregnant women are considered to be at a greater risk of severe morbidity and mortality from other respiratory infections such as influenza.
      • Sappenfield E.
      • Jamieson D.J.
      • Kourtis A.P.
      Pregnancy and susceptibility to infectious diseases.
      Admission to the ICU signifies a more severe course of disease. Therefore, our findings are reassuring and indicate that pregnant women with COVID-19 may not experience more severe disease progression than nonpregnant women.

      References

        • Rasmussen S.A.
        • Smulian J.C.
        • Lednicky J.A.
        • Wen T.S.
        • Jamieson D.J.
        Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know.
        Am J Obstet Gynecol. 2020; 222: 415-426
        • Della Gatta A.N.
        • Rizzo R.
        • Pilu G.
        • Simonazzi G.
        COVID19 during pregnancy: a systematic review of reported cases.
        Am J Obstet Gynecol. 2020; ([Epub ahead of print])
        • Yan J.
        • Guo J.
        • Fan C.
        • et al.
        Coronavirus disease 2019 (COVID-19) in pregnant women: a report based on 116 cases.
        Am J Obstet Gynecol. 2020; ([Epub ahead of print])
        • Centers for Disease Control and Prevention
        Symptoms of coronavirus.
        (Available at:)
        • Tekbali A.
        • Grünebaum A.
        • Saraya A.
        • McCullough L.
        • Bornstein E.
        • Chervenak F.A.
        Pregnant versus non-pregnant SARS-CoV-2 and COVID-19 hospital admissions: the first 4 weeks in New York.
        Am J Obstet Gynecol. 2020; ([Epub ahead of print])
        • Sappenfield E.
        • Jamieson D.J.
        • Kourtis A.P.
        Pregnancy and susceptibility to infectious diseases.
        Infect Dis Obstet Gynecol. 2013; 2013: 752852

      Linked Article

      • Intensive care unit admissions for pregnant and nonpregnant women with coronavirus disease 2019
        American Journal of Obstetrics & GynecologyVol. 223Issue 5
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          We enjoyed reading the article by Blitz et al1 entitled “Intensive care unit admissions of pregnant and nonpregnant women with coronavirus disease 2019,” recently published in the American Journal of Obstetrics & Gynecology. The researchers did not find an increased risk for intensive care unit (ICU) admission in hospitalized pregnant women diagnosed with coronavirus disease 2019 (COVID-19) compared with those who were not pregnant and concluded that the results were reassuring as they indicated that pregnant women infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may not experience more severe disease progression than nonpregnant women.
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