Clinical characteristics, symptoms, management and health outcomes in 8,598 pregnant women diagnosed with COVID-19 compared to 27,510 with seasonal influenza in France, Spain and the US: a network cohort analysis
| Main Authors: | Lana Yin Hui Lai, Asieh Golozar, Anthony Sena, Andrea V. Margulis, Nuria Haro, Paula Casajust, Neus Valveny, Albert Prats-Uribe, Evan P. Minty, Waheed-Ul-Rahman Ahmed, Thamir M Alshammari, Daniel R. Morales, Heba Alghoul, Osaid Alser, Dalia Dawoud, Lin Zhang, Jose D. Posada, Nigam H. Shah, Clair Blacketer, Carlos Areia, Vignesh Subbian, Fredrik Nyberg, Jennifer C E Lane, Marc A Suchard, Mengchun Gong, Martina Recalde, Jitendra Jonnagaddala, Karishma Shah, Elena Roel, David Vizcaya, Stephen Fortin, Ru-fong Joanne Cheng, Christian Reich, George Hripcsak, Peter Rijnbeek, Patrick Ryan, Kristin Kostka, Talita Duarte-Salles, Daniel Prieto-Alhambra |
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| Format: | info publication-preprint Journal |
| Terbitan: |
, 2020
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| Subjects: | |
| Online Access: |
https://zenodo.org/record/4270489 |
Daftar Isi:
- OBJECTIVES To describe comorbidities, symptoms at presentation, medication use, and 30-day outcomes after a diagnosis of COVID-19 in pregnant women, in comparison to pregnant women with influenza. DESIGN Multinational network cohort SETTING A total of 6 databases consisting of electronic medical records and claims data from France, Spain, and the United States. PARTICIPANTS Pregnant women with ≥ 1 year in contributing databases, diagnosed and/or tested positive, or hospitalized with COVID-19. The influenza cohort was derived from the 2017-2018 influenza season. OUTCOMES Baseline patient characteristics, comorbidities and presenting symptoms; 30-day inpatient drug utilization, maternal complications and pregnancy-related outcomes following diagnosis/hospitalization. RESULTS 8,598 women diagnosed (2,031 hospitalized) with COVID-19 were included. Hospitalized women had, compared to those diagnosed, a higher prevalence sof pre-existing comorbidities including renal impairment (2.2% diagnosed vs 5.1% hospitalized) and anemia (15.5% diagnosed vs 21.3% hospitalized). The ten most common inpatient treatments were systemic corticosteroids (29.6%), enoxaparin (24.0%), immunoglobulins (21.4%), famotidine (20.9%), azithromycin (18.1%), heparin (15.8%), ceftriaxone (7.9%), aspirin (7.0%), hydroxychloroquine (5.4%) and amoxicillin (3.5%). Compared to 27,510 women with influenza, dyspnea and anosmia were more prevalent in those with COVID-19. Women with COVID-19 had higher frequency of cesarean-section (4.4% vs 3.1%), preterm delivery (0.9% vs 0.5%), and poorer maternal outcomes: pneumonia (12.0% vs 2.7%), ARDS (4.0% vs 0.3%) and sepsis (2.1% vs 0.7%). COVID-19 fatality was negligible (N<5 in each database respectively). CONCLUSIONS Comorbidities that were more prevalent with COVID-19 hospitalization (compared to COVID-19 diagnosed) in pregnancy included renal impairment and anemia. Multiple medications were used to treat pregnant women hospitalized with COVID-19, some with little evidence of benefit. Anosmia and dyspnea were indicative symptoms of COVID-19 in pregnancy compared to influenza, and may aid differential diagnosis. Despite low fatality, pregnancy and maternal outcomes were worse in COVID-19 than influenza.