Eighteen-Month Outcomes Among Pregnant and Nonpregnant Reproductive-Aged People Hospitalized for Coronavirus Disease 2019

Lisa M Bebell; Ann E Woolley; Kaitlyn E James; Andy Kim; Mary-Ruth Joyc; Kathryn J Gray; Caitlin Radford; Ingrid V Bassett; Adeline A Boatin; Andrea L Ciaranello; Sigal Yawetz; Andrea G Edlow; Ilona T Goldfarb; Khady Diouf

doi:10.1093/ofid/ofae278

Eighteen-Month Outcomes Among Pregnant and Nonpregnant Reproductive-Aged People Hospitalized for Coronavirus Disease 2019

Open Forum Infect Dis. 2024 Jul 8;11(7):ofae278. doi: 10.1093/ofid/ofae278. eCollection 2024 Jul.

Authors

Affiliations

¹ Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² Department of Medicine, Division of Infectious Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA.
⁵ Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁶ Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Abstract

Background: Physiologic and immunologic adaptations in pregnancy may increase the risk of adverse outcomes from respiratory viral infections. However, data are limited on longer-term outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy prior to widespread vaccine availability.

Methods: Using electronic health record data, we retrospectively compared 6-, 12-, and 18-month outcomes including death and rehospitalization between pregnant and nonpregnant reproductive-aged individuals hospitalized for SARS-CoV-2 infection between 2020 and 2021 at 2 academic referral hospitals.

Results: There were 190 nonpregnant and 70 pregnant participants. Mean age was 31 years for pregnant and 34 years for nonpregnant participants. For pregnant patients, mean gestational age at coronavirus disease 2019 (COVID-19) diagnosis was 36 weeks, 54% delivered by cesarean, and 97% delivered a live birth. Compared to pregnant participants, nonpregnant participants had a higher prevalence of baseline comorbidities and a higher proportion received mechanical ventilation (84% vs 55%). Index hospitalization complications (31% vs 17%) and mortality (3% vs 0%) were more common in nonpregnant participants. Over 18 months following index hospitalization, 39 (21%) nonpregnant and 5 (7%) pregnant participants were readmitted, most for infection (28/44 [64%]). Most readmissions occurred within 6 months. There were no posthospitalization deaths in the pregnant group.

Conclusions: Pregnant people with severe COVID-19 disease had a low rate of severe adverse outcomes after index hospitalization. The low readmission rate is reassuring that pregnant individuals may not be at higher risk for long-term severe adverse health outcomes after COVID-19 compared to the nonpregnant reproductive-aged population, possibly because any increased risk conferred by pregnancy resolves soon after delivery.

Keywords: COVID-19; SARS-CoV-2; birth; maternal; pregnancy.

Abstract

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