1. The risk of maternal morbidity, mortality, and adverse perinatal outcomes was higher among pregnant women with a COVID-19 infection than matched controls.
2. Among COVID-positive patients, the severity of symptoms was associated with increased maternal and perinatal complications.
Evidence Rating Level: 2 (Good)
Study Rundown: Existing literature has demonstrated increased morbidity and mortality related to COVID-19 infections during pregnancy. However, the extent to which this remains true for the omicron (B.1.1.529) variant is unclear. This prospective cohort study aimed to compare maternal and perinatal outcomes in vaccinated and unvaccinated pregnant mothers with confirmed omicron-associated COVID-19. The co-primary endpoints included the maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). According to study results, COVID-19 in pregnancy was associated with increased maternal morbidity and mortality, with the greatest impact among women who were symptomatic and unvaccinated. Furthermore, the risk of adverse pregnancy-related outcomes was associated with increased severity of COVID-19 symptoms. This study was strengthened by a large sample size of pregnant women with and without a COVID-19 diagnosis, thus adding to its validity.
Click to read the study in The Lancet
Relevant Reading: Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons
In-depth [prospective cohort]: Between Nov 27, 2021, and Jun 30, 2022, 4618 patients were enrolled in the study (1545 with COVID-19 and 3073 with no known COVID-19 diagnosis) from 41 hospitals in 18 countries. Included were women with laboratory-confirmed COVID-19 who delivered between the study timeframe. The co-primary endpoints of MMMI, SNMI, and SPMMI were higher in the COVID-positive group compared to the COVID-negative group (MMMI: relative risk [RR] 1.16, 95% confidence interval [CI] 1.03-1.31, SNMI: RR 1.23, 95% CI 0.88-1.71, and SPMMI: RR 1.21, 95% CI 1.00-1.46). The severity of symptoms in the COVID-positive group was associated with increased maternal (RR 2.51, 95% CI 1.84-3.43) and perinatal (RR 1.84, 95% CI 1.02-3.34) complications, as well as admission to the ICU or death (RR 11.83, 95% CI 6.67-20.97). Among those considered to be fully vaccinated, vaccine effectiveness for severe COVID-19 complications was 56% and 76% for those with a booster dose. Overall, findings from this study suggest that omicron-positive COVID-19 in pregnancy significantly increases morbidity and mortality.
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