Symptomatic COVID-19 at pregnancy end tied to increased complications in mothers, infants

Expectant mothers with symptomatic COVID-19 upon hospital admission for delivery had a higher risk of emergency complications surrounding delivery, according to a small retrospective study from the US presented at Anesthesiology 2021. Furthermore, infants born to symptomatic mothers were more likely to require intensive care unit (ICU) admission or respiratory support.

Study participants were 102 individuals aged 16–45 years (mean age 26.76 years) who were admitted for singleton delivery at the University of Texas Medical Branch Galveston Labor and Delivery Department, Galveston, Texas, US, between March and September 2020, and who tested positive for COVID-19 upon admission.

Of these, 71 mothers were asymptomatic and 31 symptomatic at hospital admission. Symptoms present were fever (42 percent), cough (39 percent), shortness of breath (26 percent), muscle pain (16 percent), chills (16 percent), and chest pain (10 percent).

Mean maternal BMI at admission was 34.09 kg/m² and was higher among symptomatic than asymptomatic women (35.01 vs 33.68 kg/m²). Gestational age at admission was a mean 37.71 weeks and similar between symptomatic and asymptomatic women (37.23 and 37.92 weeks, respectively).

About 30 percent of mothers were admitted for planned elective Caesarean section (C-section). Overall, 62.70 percent underwent C-section, 64.50 and 62 percent of symptomatic and asymptomatic mothers, respectively, and 37.30 percent underwent vaginal delivery (35.50 and 38.00 percent, respectively).

Fifty percent of mothers had emergency circumstances surrounding delivery*, with a higher likelihood among mothers with symptomatic compared with asymptomatic COVID-19 (58.10 percent vs 46.50 percent). [Anesthesiology 2021, abstract A4111]

“This increase in the prevalence of emergent C-section with symptomatic infection could be caused by the reduced oxygenation and endothelial cell dysfunction. This potential for poor oxygenation could also contribute to the difference in neonatal outcomes recorded,” the authors said.

Certain emergency complications were more common among symptomatic vs asymptomatic mothers and these included breech position, decreased foetal movement, insufficient amniotic fluid, and slowing or stopping of progression of labour.

In terms of neonatal outcomes, 38.20 percent of infants required admission to the neonatal intensive care unit (NICU), a more common occurrence in infants born to symptomatic than asymptomatic mothers (45.20 percent vs 35.20 percent). About 29 percent of infants required respiratory support which was also more common in infants born to symptomatic than asymptomatic mothers (32.30 percent vs 28.20 percent). There were no incidents of seizure, hypoxic ischaemic encephalopathy, meconium aspiration, or birth trauma in either group.

Eight infants were not tested for COVID-19 in hospital. One infant, born at 35 weeks 1 day to a symptomatic mother with respiratory distress, tested positive for COVID-19 and remained so at the repeat PCR test and NAAT nasopharyngeal swab 48 hours later. The infant was admitted to the NICU for four days with oxygen support.

“[T]he one case of the neonate who tested positive for COVID after delivery is concerning for possible vertical COVID transmission in utero,” noted the authors, highlighting that personal protective equipment (PPE) protocols were followed during the emergency C-section delivery of said infant, which was carried out due to severe maternal COVID symptoms. Furthermore, maternal contact with the infant was via telephone only.

“Given the evolving nature of COVID-19, it is critical for hospitals to share their experiences of how patients with COVID-19 are treated and how it affects patient outcomes,” said study lead author, medical student Kristine Lane, and senior author, Assistant Professor Rovnat Babazade from the University of Texas Medical Branch, Galveston, Texas.

“COVID-19 has severe systemic effects on the body, especially [in] symptomatic patients,” added Lane. “It is possible that these effects are amplified in pregnant mothers, who have increased foetal and maternal oxygen demands,” she said.

The authors noted that the proportion of C-sections in this study were higher than the US population C-section rate (31.7 percent). While the increase in C-sections could be attributed to reduced oxygenation, it is also possible that concerns over the “unpredictable nature” of the virus could lead to recommendation for this type of delivery in medium- to high-risk deliveries, Lane concluded.