Pregnancy During a Pandemic: A Cohort Study Comparing Adverse Outcomes During and Before the COVID-19 Pandemic.
Academic Article
Overview
abstract
OBJECTIVE: To evaluate how the COVID-19 pandemic may have negatively impacted birth outcomes in patients who tested negative for the SARS-CoV-2 virus. STUDY DESIGN: We conducted a retrospective cohort study using electronic health records of pregnant women admitted to a tertiary medical center in New York City, an epicenter of the pandemic. Women with a singleton gestation admitted for delivery from March 27-May 31, 2019 and March 27-May 31, 2020 were included. Women less than 18 years old, those with a positive SARS-CoV-2 PCR test on admission, fetal anomaly, or multiple gestation were excluded. Adverse pregnancy outcomes were compared between groups. Univariable and multivariable logistic regression was used to assess outcomes. The primary outcome was preterm birth. RESULTS: Women who delivered during the 2020 study interval had a significantly higher rate of hypertensive disorders of pregnancy (gestational hypertension or preeclampsia) (OR 1.40, 95% CI 1.05-1.85; p=0.02), postpartum hemorrhage (PPH) (OR 1.77, 95% CI 1.14-2.73; p=0.01), and preterm birth (OR 1.49, 95% CI 1.10-2.02; p=0.01). Gestational age at delivery was significantly lower in the 2020 cohort compared to the 2019 cohort (39.3 vs. 39.4 weeks, p=0.03). After adjusting for confounding variables, multivariate analysis confirmed a persistent increase in hypertensive disorders of pregnancy (OR=1.56, 95% CI 1.10-2.20, p=0.01), postpartum hemorrhage (OR=1.74, 95% CI: 1.06-2.86, p=0.03), and preterm birth (OR=1.72, 95% CI: 1.20-2.47, p=0.003) in patients who delivered in 2020 compared to the same period in 2019. Specifically, medically indicated preterm births increased during the pandemic (OR=3.17, 95% CI: 1.77-5.67, p<0.0001). CONCLUSION: Those who delivered during the COVID-19 pandemic study interval were more likely to experience hypertensive disorders of pregnancy, medically indicated preterm birth, and postpartum hemorrhage even in the absence of SARS-CoV2 infection.
