‘Rare’ study finds low in-hospital mortality among pregnant women with COVID-19
The rate of in-hospital mortality was lower among pregnant women with COVID-19 than nonpregnant women with COVID-19, according to a new study in Annals of Internal Medicine.
The findings conflict with previous research; however, Beth Pineles, MD, PhD, a maternal‐fetal medicine fellow with McGovern Medical School at UTHealth in Houston, and colleagues noted that earlier studies were limited by missing data, including pregnancy status, and likely had “biased case ascertainment.”
The current study utilized the Premier Healthcare Database, “which captures 20% of U.S. discharges in an automated fashion from electronic medical records and provides a complete list of all patients who were discharged from the participating hospitals,” Pineles told Healio Primary Care.
“Thus, we are very unlikely to be missing patients, and the data are robust,” she added.
The researchers analyzed data from 1,062 pregnant and 9,815 nonpregnant female patients aged 15 to 45 years who were hospitalized with COVID-19 and viral pneumonia. The pregnant patients tended to be younger, more likely to have public insurance and less likely to have comorbidities such as hypertension, chronic pulmonary disease, diabetes and obesity, according to the researchers.
Pineles and colleagues reported that in-hospital death occurred in 0.8% (n = 9) of the pregnant patients and 3.5% (n = 340) of nonpregnant patients. The median time from admission to death was 18 days (interquartile range, 6-28 days) for pregnant patients and 12 days (interquartile range, 5-23 days) for those who were not pregnant.
In a subgroup of in-hospital patients admitted to an ICU, 3.5% of 255 pregnant patients experienced mortality, as did 14.9% of 1,898 patients who were not pregnant. Among the in-hospital patients who received mechanical ventilation, 8.6% of the 105 pregnant patients and 31.4% of the 937 nonpregnant patients died.
The ages of the nine pregnant women who died ranged from 23 to 44 years, and the gestational age was between 23 and 39 weeks. Seven of the women had live births before death, according to the researchers. Eight of the deaths occurred in non-Hispanic Black or Hispanic pregnant women. In addition, six deaths were among women were obese and seven were among women with at least one comorbidity.
Pineles said that the current study “is rare in its finding that pregnant patients are not at increased risk for death from COVID‐19 than nonpregnant patients,” but recent data from the United Kingdom support the findings.
“Previous CDC reports were based on selective reporting and a lot of data were missing,” Pineles said. “Our results likely represent the true risk of COVID-19‐related death in the pregnant population.”
Despite the lower mortality rate among pregnant vs. nonpregnant patients, Pineles noted that the current study revealed a “much higher” maternal mortality rate among pregnant patients with COVID-19 — 800 per 100,000 patients — compared with the overall maternal mortality rate of 17 per 100,000 patients in the U.S.
“Protection from COVID‐19 with vaccination, masking and social distancing when necessary is important for pregnant women,” she said. “However, we hope that our study can help alleviate some of the anxiety and stress that negatively affects patients’ health.”