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Canadian surveillance of COVID-19 in pregnancy: Epidemiology and maternal and infant outcomes

      Objectives

      To describe the Canadian approach to rapid epidemic surveillance through the CANCOVID-Preg network.
      To assess the burden of COVID-19 in pregnancy and associated maternal and infant outcomes in Canada.

      Methods

      We mobilized an established network of care providers in response to the global pandemic due to a paucity of data on COVID-19 in pregnancy. We engaged leads in each province/territory to develop an approach for identification of all cases of SARS-CoV-2 in pregnancy and collection of outcome data for women and infants. Women with documented infection in pregnancy are identified by public health and/or clinical identification and data collection is prospective via medical records. Data collection forms were designed to ensure harmonization between Canadian provinces/territories and with international networks (e.g. COVI-Preg, WHO).
      In Canada, it is not recommended that COVID-19 affected mother-infant pairs are separated. We will provide data to evaluate this practice. Data will be described using descriptive statistics. If sample size allows, comparisons of maternal/fetal outcomes will be made among variables (e.g., symptom severity, ventilation, treatments, maternal age, education, etc.) using regression analyses.

      Results

      The CANCOVID-Preg network and national surveillance for COVID-19 in pregnancy was rapidly implemented. Within 2 weeks of pandemic declaration, national meetings and study protocol development began. The first all-member meeting occurred at 7 weeks when organization structures had been launched in all regions. Dedicated funding was secured by 3 months. Between March 1, 2020 to June 24, 2020, 307 cases were identified in Canada, with regional distribution proportional to population. As of May 30, 2020, data have been collected for 22 pregnancies in British Columbia (BC) and 27 in Ontario (ON). In BC, mean gestational age at SARS-CoV-2 diagnosis was 20.3 weeks (±9.9, range: 5.3 - 38.3). Among those with detailed data, 31.6% (6/19) had a known positive contact in the community; 2 reported travel before diagnosis. Among 46 pregnancies (BC & ON), the most frequently documented symptoms were cough (37.0%), fever (32.6%). Two (9%) BC cases have been hospitalized due to COVID-19; no ICU admission or mechanical ventilation. Two (9%) BC and 21 (78%) ON cases have delivered. One infant (of 12 with results) in ON tested positive for SARS-CoV-2 and may represent a vertical transmission. Updated data will be presented at the IDSOG Annual Meeting.

      Conclusions

      This national surveillance project was largely enabled by national care provider networks as well as provincially dedicated database software and routine perinatal data collection. Our team will provide national data on COVID-19 in pregnancy to support clinical care of pregnant women and their infants.