Background
Objective
Study Design
Results
Conclusion
Key words
Introduction
Why was this study conducted?
Key findings
What does this add to what is known?
COVID data tracker.
- Riley L.E.
- Beigi R.
- Jamieson D.J.
- et al.
SMFM: provider considerations for engaging in COVID-19 vaccine counseling with pregnant and lactating patients.
COVID-19 vaccines while pregnant or breastfeeding.
COVID-19 vaccine monitoring systems for pregnant people.
Materials and Methods
Global Health Network. Essential Study Documents • INTERGROWTH-21st. Available at: https://intergrowth21.tghn.org/intercovid/intercovid-study-documents/. Published May 14, 2020. Accessed April 18, 2021.
Diagnosis of diabetes mellitus, high body mass, and gestational diabetes mellitus
Data management and analysis
Statistical analysis
Sensitivity analyses
Results
Characteristic | |
---|---|
Maternal age (y) | 30.2±6.1 |
Parity | |
Nulliparous | 898 (43.4) |
Parous | 1173 (56.6) |
Prepregnancy BMI (kg/m2) | 25.3±5.8 |
Normal weight, <25 kg/m2 | 1180 (57.0) |
Overweight, 25 to <30 kg/m2 | 535 (25.8) |
Obese, ≥30 kg/m2 | 356 (17.2) |
Tobacco use during pregnancy | |
Yes | 72 (3.5) |
No | 1999 (96.5) |
Preexisting diabetes mellitus | |
Yes | 53 (2.6) |
No | 2018 (97.4) |
Preexisting hypertension | |
Yes | 56 (2.7) |
No | 2012 (97.3) |
Gestational diabetes mellitus during index pregnancy | |
Yes | 194 (9.4) |
No | 1877 (90.6) |
Gestational age at delivery (wk) | 38.3±3.3 |
Variable | n (%) | COVID-19 diagnosis, n (%) | No COVID-19 diagnosis, n (%) | Unadjusted RR (95% CI) | Adjusted RR (95% CI) |
---|---|---|---|---|---|
GDM or DM | |||||
No GDM, no DM | 1824 (88.1) | 564 (30.9) | 1260 (69.1) | Ref | Ref |
GDM, no DM | 194 (9.4) | 75 (38.7) | 119 (61.3) | 1.19 (0.98–1.44) | 1.21 (0.99–1.46) |
Preexisting DM | 53 (2.6) | 33 (62.3) | 20 (37.7) | 1.88 (1.51–2.36) | 1.94 (1.55–2.42) |
BMI | |||||
Normal weight (<25 kg/m2) | 1180 (57.0) | 344 (29.2) | 836 (70.8) | Ref | Ref |
Overweight or obese (≥25 kg/m2) | 891 (43.0) | 328 (36.8) | 563 (63.2) | 1.21 (1.06–1.37) | 1.20 (1.06–1.37) |

Comment
Principal findings
Results in the context of what is known
Strengths and limitations
Clinical spectrum of SARS-CoV-2 infection. National Institutes of Health.
Guidance for maternal medicine services in the coronavirus (COVID-19) pandemic.
Guidance for maternal medicine services in the evolving coronavirus (COVID-19) pandemic.
- Yamamoto J.
- Donovan L.
- Feig D.
- Berger H.
Research implications
Clinical implications
Conclusions
Acknowledgments
Appendix
Contributors and members of the International Study on the Effects of COVID-19 in pregnancy on maternal and newborn outcomes in the International Fetal and Newborn Growth Consortium for the 21st Century global network (the INTERCOVID study)
Members of the International Study on the Effects of COVID-19 in pregnancy on maternal and newborn outcomes in the International Fetal and Newborn Growth Consortium for the 21st Century global network (the INTERCOVID study) and its Committees
Participating institutions and investigators

RT-PCR tests | Antibody tests |
---|---|
|
|
Symptoms | Women “diagnosed” with COVID-19 (n=672) n (%) |
---|---|
Chest pain | 19 (2.8) |
Diarrhea or vomiting | 48 (7.1) |
Limb or joint pain | 54 (8.0) |
Sore throat | 70 (10.4) |
Flu-like symptoms | 76 (11.3) |
Runny nose | 78 (11.6) |
Breathlessness | 84 (12.5) |
Headache | 92 (13.7) |
Tiredness or lethargy | 110 (16.4) |
Loss of smell | 116 (17.3) |
Fever | 88 (28.0) |
Cough | 232 (34.5) |
1 symptom | 66 (9.8) |
2 symptoms | 125 (18.6) |
≥3 symptoms | 209 (31.1) |
Asymptomatic | 272 (40.5) |
Variable | n (%) | COVID-19 diagnosis, n (%) | No COVID-19 diagnosis, n (%) | Unadjusted RR (95% CI) | Adjusted RR (95% CI) |
---|---|---|---|---|---|
GDM or DM | |||||
No GDM, no DM | 812 (86.7) | 282 (34.7) | 530 (65.3) | Ref | Ref |
GDM, no DM | 97 (10.4) | 43 (44.3) | 54 (55.7) | 1.20 (0.94–1.54) | 1.27 (1.01–1.61) |
Preexisting DM | 28 (3.0) | 17 (60.7) | 11 (39.3) | 1.64 (1.19–2.25) | 1.76 (1.29–2.39) |
BMI | |||||
Normal weight (<25 kg/m2) | 562 (60.0) | 182 (32.4) | 380 (67.6) | Ref | Ref |
Overweight or obese (≥25 kg/m2) | 375 (40.0) | 160 (42.7) | 215 (57.3) | 1.27 (1.07–1.51) | 1.23 (1.04–1.45) |
Variable | N (%) | Crude RR (95% CI) | Adjusted RR (95% CI) |
---|---|---|---|
Model 1 | |||
GDM or DM | |||
No GDM, no DM | 1123 (87.1) | Ref | Ref |
GDM, no DM | 123 (9.5) | 1.13 (0.95–1.35) | 1.18 (0.99–1.40) |
Preexisting DM | 44 (3.4) | 1.52 (1.27–1.83) | 1.60 (1.33–1.91) |
BMI | |||
Normal weight (<25 kg/m2) | 750 (58.1) | Ref | Ref |
Overweight or obese (≥25 kg/m2) | 540 (41.9) | 1.27 (1.13–1.43) | 1.24 (1.11–1.40) |
Model 2 | |||
No GDM or DM, normal weight | 696 (54.0) | Ref | Ref |
No GDM or DM, overweight or obese | 427 (33.1) | 1.26 (1.11–1.43) | 1.23 (1.09–1.40) |
GDM without insulin, normal weight | 34 (2.6) | 0.93 (0.60–1.44) | 0.96 (0.63–1.45) |
GDM without insulin, overweight or obese | 58 (4.5) | 1.30 (1.01–1.68) | 1.33 (1.04–1.72) |
GDM with insulin, normal weight | 9 (0.7) | 1.62 (1.01–2.60) | 1.73 (1.13–2.64) |
GDM with insulin, overweight or obese | 22 (1.7) | 1.88 (1.47–2.40) | 1.91 (1.52–2.41) |
Preexisting DM, normal weight | 11 (0.9) | 1.55 (0.98–2.44) | 1.63 (1.05–2.53) |
Preexisting DM, overweight or obese | 33 (2.6) | 1.92 (1.57–2.34) | 1.97 (1.62–2.38) |
Variable | n (%) | Adjusted RR (95% CI) |
---|---|---|
Model 1 | ||
GDM or DM | ||
No GDM, no DM | 1824 (88.1) | Ref |
GDM, no DM | 194 (9.4) | 1.23 (1.01–1.49) |
Preexisting DM | 53 (2.6) | 1.93 (1.54–2.42) |
BMI | ||
Normal weight (<25 kg/m2) | 1180 (57.0) | Ref |
Overweight or obese (≥25 kg/m2) | 891 (43.0) | 1.21 (1.07–1.38) |
Model 2 | ||
No GDM or DM, normal weight | 1099 (53.1) | Ref |
No GDM or DM, overweight or obese | 725 (35.0) | 1.20 (1.05–1.38) |
GDM without insulin, normal weight | 54 (2.6) | 1.01 (0.65–1.55) |
GDM without insulin, overweight or obese | 87 (4.2) | 1.37 (1.03–1.83) |
GDM with insulin, normal weight | 14 (0.7) | 1.81 (1.07–3.08) |
GDM with insulin, overweight/obese | 39 (1.9) | 1.81 (1.31–2.51) |
Preexisting DM, normal weight | 13 (0.6) | 1.94 (1.18–3.18) |
Preexisting DM, overweight or obese | 40 (1.9) | 2.33 (1.82–3.00) |
Variable | n (%) | Crude RR (95% CI) | Adjusted RR (95% CI) |
---|---|---|---|
Model 1 | |||
GDM or DM | |||
No GDM, no DM | 1824 (88.1) | Ref | Ref |
GDM, no DM | 194 (9.4) | 1.16 (0.96–1.40) | 1.18 (0.97–1.42) |
Preexisting DM | 53 (2.6) | 1.84 (1.47–2.30) | 1.89 (1.52–2.36) |
BMI | |||
Normal weight (<25 kg/m2) | 1180 (57.0) | Ref | Ref |
Overweight or obese (≥25 kg/m2) | 891 (43.0) | 1.19 (1.05–1.35) | 1.19 (1.05–1.34) |
Model 2 | |||
No GDM or DM, normal weight | 1099 (53.1) | Ref | Ref |
No GDM or DM, overweight or obese | 725 (35.0) | 1.18 (1.04–1.35) | 1.18 (1.03–1.35) |
GDM without insulin, normal weight | 54 (2.6) | 0.94 (0.61–1.46) | 0.96 (0.62–1.48) |
GDM without insulin, overweight or obese | 87 (4.2) | 1.27 (0.95–1.68) | 1.29 (0.97–1.71) |
GDM with insulin, normal weight | 14 (0.7) | 1.68 (0.99–2.87) | 1.74 (1.03–2.92) |
GDM with insulin, overweight or obese | 39 (1.9) | 1.73 (1.26–2.38) | 1.72 (1.25–2.37) |
Preexisting DM, normal weight | 13 (0.6) | 1.81 (1.09–3.02) | 1.87 (1.14–3.08) |
Preexisting DM, overweight or obese | 40 (1.9) | 2.19 (1.71–2.80) | 2.24 (1.76–2.87) |
Variable | COVID-19 without symptoms, n (%) | COVID-19 with symptoms, n (%) | RR (95% CI) |
---|---|---|---|
All women with COVID-19 | |||
GDM or DM | |||
No GDM, no DM | 226 (40.1) | 338 (59.9) | Ref. |
GDM, no DM | 32 (42.7) | 43 (57.3) | 0.96 (0.88–1.03) |
Preexisting DM | 14 (42.4) | 19 (57.6) | 0.97 (0.87–1.07) |
BMI | |||
Normal weight (<25 kg/m2) | 152 (44.2) | 192 (55.8) | Ref. |
Overweight or obese (≥25 kg/m2) | 120 (36.6) | 208 (63.4) | 1.06 (1.01–1.11) |
Women with a positive RT-PCR or antigen test in the week before or on the day of delivery | |||
GDM or DM | |||
No GDM, no DM | 164 (58.2) | 118 (41.8) | Ref. |
GDM, no DM | 25 (58.1) | 18 (41.9) | 0.97 (0.87–1.09) |
Preexisting DM | 9 (52.9) | 8 (47.1) | 1.02 (0.87–1.20) |
BMI | |||
Normal weight (<25 kg/m2) | 114 (62.6) | 68 (37.4) | Ref. |
Overweight or obese (≥25 kg/m2) | 84 (52.5) | 76 (47.5) | 1.08 (1.00–1.09) |
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Article info
Publication history
Footnotes
J.V. and A.T.P. contributed equally to this work.
B.E., R.B.G., and S.R. reported receiving grants from the Oxford University during the conduct of the study and the US National Institutes of Health. A.T.P. reported receiving grants from the National Institute for Health Research Biomedical Research Centre and support from Intelligent Ultrasound as director outside the submitted work. The other authors report no conflict of interest.
The study was supported by the COVID-19 Research Response Fund from the University of Oxford (reference number 0009083). The investigators acknowledge the philanthropic support of the donors to the University of Oxford’s COVID-19 Research Response Fund. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Cite this article as: Eskenazi B, Rauch S, Iurlaro E, et al. Diabetes mellitus, maternal adiposity, and insulin-dependent gestational diabetes are associated with COVID-19 in pregnancy: the INTERCOVID study. Am J Obstet Gynecol 2022;227:74.e1-16.