COVID-19 in pregnancy: A cross-sectional study on clinical features, disease severity, and health outcome

TL;DR

This study compares how pregnant and non-pregnant women experience and recover from COVID-19, finding more severe symptoms in pregnant women but better survival rates.

Contribution

The study provides new insights into the clinical differences and outcomes of COVID-19 in pregnant versus non-pregnant women.

Findings

Pregnant women with COVID-19 had higher odds of requiring intensive care but lower odds of death compared to non-pregnant women.

Pregnant women reported more frequent diarrhea and skin lesions, and had higher rates of diabetes and hypertension.

Cough and fever were the most common symptoms in pregnant women, while cough and muscle ache were more common in non-pregnant women.

Abstract

Assessing the impact of coronavirus disease 2019 (COVID-19) reveals unique challenges for pregnant women, who experience distinct clinical manifestations and health outcomes compared to their non-pregnant counterparts. We aimed to evaluate the clinical features, disease severity, and health outcomes of COVID-19 in pregnant women and compare them to those of non-pregnant women. In this population-based study, we included all women diagnosed with COVID-19 across the province of Tehran during the first two years of the epidemic. Descriptive statistics, the chi-squared test, and the logistic regression model were applied. Overall, 79,338 non-pregnant women and 3249 pregnant women diagnosed with COVID-19 were included. Pregnant women were most commonly in the age group of 25–34 years (54%, n ═ 1758), while the age group of 34–44 had the highest representation among non-pregnant women (56%, n ═ 44,492). After accounting for age and comorbidities, pregnancy was associated with an increased risk of requiring intensive care (odds ratio [OR] 1.38, confidence interval [CI] 1.223–1.564). However, the probability of dying due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was lower in pregnant women compared to non-pregnant women (OR 0.55, CI 0.394–0.793). Cough (41%) and fever (30%) were the most frequent clinical presentations in pregnant women, whereas cough (57%) and muscle ache (38%) were the most common symptoms in non-pregnant women. Furthermore, diarrhea (P < 0.001) and skin lesions (P < 0.001) were reported more frequently by pregnant patients than non-pregnant patients. A significant prevalence of diabetes (P < 0.001), hypertension (P < 0.001), cancers (P < 0.001), and chronic hematological diseases (P < 0.001) was observed in pregnant patients. In conclusion, COVID-19-infected pregnant women exhibit different clinical manifestations and a more severe clinical course but have better health outcomes compared to their non-pregnant counterparts.